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��� � <br />� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7032 <br />Massage Therapy Establishment License Application <br />r�� i -�-� r . <br />J�,�a;r�ss �;��r,- ' � 1 �•�'� ��F'�-��-� � �, 4� i- �'� i � � �l.t�����r � - <br />B�isin,e� Ad�*.as <br />�� � ���� � � ,,� � �� , <br />5usii�s� Phan� ��3 �� ,�� `� _.����_ <br />Person to Contact in Regard to Business License: <br />��,t7� _ I ' � .� �' y L ��� • k~' ,�`�C.� i ] <br />�� , � <br />Address <br />Phone <br />Drivers License Number_ <br />Social Security NiunUer _ _ _„ <br />U.S, Citizen? Yes No <br />��.� 4 ��-J.• 1.� <br />% ! <br />Date of Birth , --. , <br />��= <br />Naturalized? <br />If yes, date and place: <br />`�� No <br />I hereby apply far the following license(s) far die term of one year, beginning July 1, �� th �' � , and ending June <br />31, �� �i �"� , in the City of Roseville, County of Ramsey, State of Miiviesota. <br />License Repuired 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 the laws of the State of Minnesota and regulation as <br />the Council of the City of Roseville �a� frona titne to time prescribe, including Minnesota Stahie #176.182. <br />., <br />����;��•�s_� �i�'�rL� ��J� �'� <br />D�l� � � <br />If completed license should be mailed somewhere other than the business address, please advise. <br />