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� <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 />L7V.�1���L•�3 �y���i. ���������_ �•_ �� � k���'} � � � i' I �L~,.'i�11����� � ai�_ i� <br />[� i i�i iti��s Ad�lr�sa � � {.� � • �••� � i�' 3 �_. � t�.r �_ �`� �_ • ��* � ��l � <br />— •-- _ — — __ _� �— <br />k - <br />� ��`� �f I � �. �. - ��� �� �• �� � � } � I � <br />+ r�kti r - �� �+ . �~r � <br />�ii5lit�Sti E}�l{!17C 4L•' -• I � _ {� f � � �7 <br />Pe� sorz to Contact i�t Regard to Btrsi�zess License: <br />, i <br />1��: i�. � ��- �_� ��.� �'�4� <br />Address <br />Phone <br />Drivers License Number <br />Social Security Number <br />U.S. Citizen? Yes <br />—,------ <br />Date of Birth <br />- t„ <br />No Naturalized? Yes No <br />If yes, date and place: <br />I hereby ap ly for the following license(s) far the ternl of one year, beginning July 1, (��� , and ending <br />June 31, �j``j , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reauired <br />Eee <br />Massage Therapy Establishment $300.00 <br />$150.00 Background Check <br />(new license only) <br />The undersigned applicant makes this application ���v:�n� S�x �a S[�� ]�,�� �f the State of Minnesota and regulation <br />as the Council of the City of Roseville may from time �� t�r��r'r�scnhe, � I�din� Minnesota Statue #176,182. <br />1 r <br />��I ° � ,I <br />Signature I ���� �,� �Y� � �•�� --"'�--' <br />�,..i ' <br />l�a�� . �l�i� J . j-�:+._i <br />If completed license should be mailed somewhere other than the business address, please advise. <br />