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�� �L <br />�� <br />City of Roseville <br />Finance Department, License Division <br />2664 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7032 <br />I�����a�� �'���°��y Establishment License Application <br />!7��_�: .ti.y5 ��:j�i. � t '�L }�-L't�'k�ti� �M1r fs�FF'4_ �.�.'i �'_• til•[ L ,• �� I 4C.' S 1 _ __— <br />5 <br />iJ � ,� <br />r5 � <br />Business Address _I �% i.: i� �,�� , �-��.�,,� ��� t°� _ <br />L <br />. '` ��� k����1��� � � � ����� �} <br />[i�isia��s �hor��: 4� � � '- ' �� - � � �� _ <br />{��r ;�; �, to Ca�tcrct in Regard to Business License: <br />� � r <br />Name —���+w��;'{.��r -- <br />..� . <br />�ly,��:.� r f' . c r. 1 i � L r� <br />r�:�d res _ ' 1 � t,) �', ���r r r `� }�Y1E'�'_. � '•�4 i �� . �! �����'� �� <br />Phone ._.. �`������� � �� �' � Date of Birth <br />Drivers License Number <br />Social Security Number <br />U.S.Citizen? ,— .�'�3 No Nahualized? <br />If yes, date and place: <br />Yes <br />� <br />I hereby apply for the following license(s) for the ternt of one year, beginning July 1, }{� r- , and ending <br />June 31, ,. ��' C��, �� , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required <br />Fee <br />Massage Therapy Establishment $300.00 <br />$150.00 Bacicground Checic <br />(new license only) <br />The undersigned applicant malces this application pursuant t� al I 1]�� l�w� �F the ��[�� of Minnesota and regulation <br />as the Council of t11e City of Roseville may from time to ci ::� nes�.rsLx, �i7cl�,d���� �{::����s�,rs Statue #176.182. <br />�-,��- <br />Signature ���������� �` f <br />��•` � ' � , <br />�at0 <br />�f �ompleted license should be mailed somewhere other than the business address, please advise. <br />