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2004_0524_Packet
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2004_0524_Packet
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� � <br />r � <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 />Business Name � � � ! i �_t_ '��_1�; ��, .�:� _ ^ <br />1� i��;�i ti�s r�c3�lr�s� ��� ti r�i7l� � � 4 I�. �? � ti l�i; �Y• _ ^ <br />� � � -f�� ��}� � � <br />I�asi�i�ss �hane £] — � � _ �. . <br />Person to Contact in Regard to Business License: <br />N��,c �� � ' _�� <br />Address .— <br />Phone <br />Drivers License Number <br />Social Security Number <br />U.S. Citizen? Yes No <br />Date of Birth <br />Naturalized? <br />If yes, date and place: <br />Yes No <br />I hereby apply for the following license(s) for the term of one year, beginning July 1, , and ending <br />June 31, , in the City of Roseville, County of Ranisey, State of Minnesota. <br />License Reauired <br />Eee <br />Massage Therapy Establishment �C�I}.(}I] :. <br />$150.0 Bacicground Checic <br />(new license only) <br />The undersigned applicant malces this application pursuant to all the laws of the State of Minnesota and regulation <br />as the Council of the City of Roseville may fro�n I im�. i� �im� p�res�ri b�._�n�:l�rd in� Minnesota Statue # 176.182. <br />�r <br />�7�,T7�SRlT� _ �-* � � �. �� � <br />�'' ~•�' <br />,� <br />��. � � - ���:f� � � :�� r��.�� �� <br />If completed license should be mailed somewhere other than the business address, please advise. <br />
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