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� � �a_� _ 1 _' _ 1 � _ J <br />� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55ll3 <br />(651)792-7034 <br />Massage Therapy Establishment License Application <br />BusinessName ��� 5''���;f��'}�,�: i I�J�F�f <br />Business Address � � I "� ! �f��`� �1ti-i � l ) �R. �11i � ��� � — �� .�:.� � �� .�� � � � <br />Business Phone �?� `�,�� � <br />�rraail Address <br />Person to Contact in Regard to Business License: <br />Legal Name �.1 li� i�: �5��• � I•.��� 1 <br />Address <br />Phone <br />Drivers License Numbe <br />'ate of Birth _ <br />I hereby apply for the following licc�se(s} for the term of one year, baginning July 1, .���"{� , and ending June <br />31, ���� , in the City of Roseville, Co�nty of Ramsey, State of Minnesota. <br />License Required Eee <br />Massage Therapy Establishment $300.00 <br />$150.00 Background Check <br />(new license only) <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation as <br />the Council of the City of Roseville may from time to time prescribe, including Minnesota Statue #1 7G, �$2. <br />� <br />Signature ��_J,�.��+� _ _ <br />� <br />� �:aie ��' _���',�J ��.r � .r�'�'r• <br />ff completed license should be mailed somewhere other than the business address, please advise. <br />