Laserfiche WebLink
� <br />� <br />Finance Department, License Division <br />2660 �i�+vae Center Drive, �:taseva�le, �I 55113 <br />(651) 792-7034 <br />Massage Therapist License <br />New License Renewal <br />For Licenseyear endiing June 30 �.�i �� � <br />1. Legal Name�'��,�,� . �i ��# �� �1.����*'� � � . � e r� � � .�€' ��� <br />�. NoR� ��= <br />--- --� r <br />3. �-io�xe Telephone <br />4. Date of Pirih <br />�� r <br />5. �7ri�ems License Number- <br />� <br />6. �u�ail Address <br />7. Haue you ever used or been known by airy name other than the legal name given in number 3 above? <br />'�� _,__ �' _,� :-- ff yes, list eac� name along with dates and places where used. <br />8. Name and address of the licensed Massage Therapy Establishmentfk�ai you expect to be ��'� by. <br />�� �� �� , �. � �`" ������ ������ . ���.. <br />9. Attach a��'�ed copy of a diploma or certificate of graduation from a school of massage therapy <br />including a aniniin� of 600 hours in successfully completed course wark as descz�b�d in �oseville <br />Ordinance 116, massage Therapy Establishments. <br />� 4. Have you had atry pr� --�------�- therapist license that was revoked, suspended, or not renewed? <br />�'es �— Zf yes c-x�ni� in detail. <br />Licensefee is 75.00 <br />Make checks payable to City of Ras�vi��e <br />