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1� <br />� <br />City of ltnseville <br />Finance Departmen�, I,ic�nse iDivis�on <br />2664 CYVic Center l�ri�e, �toser�lle, NyN 55113 <br />(651) 792-7Q36 <br />�ass��e 'Therapy E��ab�ishme�i L�c�nse App�icativn <br />Busir�ess Name `�1 �� � %%�? �G�� LP � <br />Business Adc�ress ��� �' �� . � c� c�- 1_ � L%!/� <br />Business Phone ��f' 7'"�� � � %`�` � <br />Email Address <br />Person to Contact in Regard to Business License: <br />L,egal Name �`��.�� � `°° /-�'- ��7L �.� L✓ <br />. � _ ,-. � . <br />Address <br />.._... . . ` <br />C.J <br />Phone ,"„ ,.._ ^ _,,,_,, Date of Birth„_,_.. <br />Drivers License Number <br />I hereby apply for the following lieense(s) for the term of one year, beginning July 1, �G�G� ' , and ending <br />June 31, �,(U , in tl�e City of Roseviile, Caunty of Ramsey, and State of Minnesata. <br />�.$ca T� <br />Massag�: Therapy Estabiishment $300.00 <br />$150.00 Background Check <br />(new license only) <br />The undersigned applicant rr�a%es Ei�is applicatzon pursuant to aii the laws of the Staie oi Minnesota and rege�lation <br />as Ehe Council of tiie City of Roseville may from fims tq tirqe prescribe, including Minnesota Statue #176.182. � <br />ac3dit�on, Ehe aQ�Gcan[ aclrnowledges tl�at they are resnonsihle, for„ .. .... ........ _..... .�?.._:._�—.... �d work history of <br />, rev�ew�n�,the ark unri„___ <br />tl�cir employee�,_inciuding;�ose that have received a massa e� thera�ist license fram t�►e Citv. <br />Signatare C%iLiL-C� ���f �'�'-C'_��. C�.��.%T <br />Da#e 3 F.f 7" �� �C�� <br />If comgiete� license shau�d be mai�ed sotnew�ere other #ha� the �usiness address, ptease advise. <br />