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��� <br />��r <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 490-2212 <br />Massage Therapy Establishment License Application <br />, �.I. <br />'� ' �r <br />J5•.iair.��3��,ir:t �I��l�ft��rti `5ti�� ��'�'41 ,�1-��,�,���4�.f�i� i�� �',E'�.�.� �'��i.��'�I ������'�� <br />_ �; } <br />�iu81 RF� A��l�ss _���__ � � �� � � �'� `_ � � – -- — — <br />���� ��� � � � � �� --- �- t - L <br />T3u�iness P]i��ae t � � � � � � � <br />P�rsaM ra �'�r,tae� �n R��rd ir� ,�:�,s;��ts f.,c���s�; <br />T,la�s�e ��� � � � �4 � �l �� �� -� � -- <br />Addr�ss �.� �� t+���� �_' f� f.�'�'�'d 0 D� ��� L� �� I� <br />Ph an� �--�� � � � �� � � � �' �]a[e of Dsnh -----� � _ �-� - + - r <br />Drivers License Nuinber _._ <br />Social Security Number _ <br />U.S. Citizen? Y°s _t Ik'� Naturalized? Yes No <br />�� S� ��:� <br />� <br />If yes, date and place: <br />� <br />T ti�r�by� u��lp� F�r ���z following license(s) for tl�e 1�tt�1i of o�te year, beginning July 1, �� , ai1d ending <br />J ui7c a I,,��,�, in the City of Roseville, County 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 �L1� laws of the State of Miimesota and regulation <br />as the Council of the City of Roseville roa� from time to time �i �e� i' �, i�i�l uti�in� �{� r�7c}u�� ue R]' n.l �? . <br />Signature <br />Date �� —� � L ���� . - - — --- <br />If completed license slioutcl be mailed some�vl�ere other than tlie business address, please advise. <br />For-office use only: <br />� ' . ... <br />