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� <br />�� � ' <br />���+K k- <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7032 <br />Massage Therapy Establishment License Application <br />} � � <br />, <br />Business Name �� ��' � ���� � � � � � �'.� � �� � <br />4 ti � � � <br />Business Address 4 � , � � �� � ��� � � � . � <br />Business Phone � � ~ / ` �� � � � � � � � <br />Persort ln Co�ttaCt ;�= Regar d to Business License: <br />' 7�r�� � � � h� � � — -� 1'�� � � w ��� <br />-� - r• - -- <br />� <br />r�dsh��s 1�� � �� �'_ �' C� �; ,�.—�k- <br />PI'.s �t �� ti��_ � ' �'� � � ` �x � y � Date of Birth _ r - s , <br />�. � <br />Drivers License Number <br />Social Security Number . - <br />U.S, Citiz� . Naturalized? � No <br />If yes, date and place: <br />T hereby �pply for the following (icense(s) for the term of one year, beginning July I, ��� , and ending June <br />���'�,�,�_, in tlie City of Roseville, County of Raansey, State of Minnesota. <br />License Reauired Pee <br />Massage Therapy Establishment $300.00 <br />$150.00 Background Chectc <br />new license only) <br />T1ie undersigned applicant makes this application pursuant to all the laws of the State o Minnesota and regulation a�s <br />the Council of the City of Roseville m�y from time to time �feeenhe, i�� ]►+�+ :esotq Sinn�e � 176,182_ <br />�ign�l;ire -� -- <br />Date �J � � � � � ' � CJ � ,' j'� <br />Ifcompleted license should be mailed somervlte�•e otlter than the business address, please advise. <br />