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�� <br />��� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7034 <br />Massage Therapy Establishment License Application <br />Business Name . 1 i 1 I r. 1- ? f+\ Cl.� <br />� 1 I r', r..� <br />��� kl:�'.'ks .�tif����';tik /.. 1_� ' � — �y t r �i•'.. L:.{.''---� �� � I•� ` . <br />R��in��s �h�r �'�,�:i ��� `� 5 ' � , I I � <br />LJ,� . � . ,L�-3.. . . _.—._ . <br />.- '� � _ �_ . ���, <br />��:1}�:I �5:�{��'.kti ', r� 7 I - l I��.�? �� � . <br />Person fo Contacf in Regard :�� Business License. <br />f.-, t� ti <br />�_t�:.� \�u7��� l. rti � k�;�- _ r'' I. �`, �� Y`-� <br />Address <br />Phone Date of Bir€]1 <br />Drivers License Number <br />I licreby apply for d7e following license{s} for tl�e term of one year, beginning ��1y 1, , and ending June <br />3�, , in dle City of Roseville, County of Ra�nsey, State of Minnesota. <br />License Required Fee <br />Massage Therapy Establisl��r�e�lt �5 yfl�i ��I <br />� I�'S�i� Background Check <br />(new license only) <br />The undersigned applicant malses this application pursuant to all tlie laws of the State of Minnesota and regulation as <br />the Council of tlie City of Roseville n�►ay from time to time prescribe, including Minnesota Statue #175.182. <br />�-� �� <br />� _•, � ti <br />Signature ,��-'"� . r- ' � �. ._ <br />� ,�`- _ <br />Date . � ti�{•r�._� <br />If completed license should be mailed somewhere other than the business address, please advise. <br />