Laserfiche WebLink
� � � <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 Nan�e <br />Business Address <br />������s$ ���,� <br />���� S <br />������ <br />� <br />��� ��'! � � �� .r_� �,.�� — <br />Persar to Cont��ct in �k�as7� to Business License: <br />Name <br />A�i ��� <br />Phone <br />n r'� <br />��� .����� ���� � �.��� �� . �"L���—'�� � <br />�� � � ' ��� — ���"�, _ Date of Birth <br />Drivers License Number <br />Social SecurityNumber <br />U. S.Citizen'? — � No Nattu�alized? <br />If yes, date and place: <br />Yes No <br />1 hereby apply for the following license(s) for the term of one year, beginning July 1, ��V'�" , and ending June <br />31. �, in the City of Roseville, County of Ran�sey, State of Minnesota. <br />License Required <br />Fee <br />Massage Therapy Establishment ,�3�0_ <br />$150.00 Background Check <br />(new license oiily) <br />The undersigned applicant makes this applicationpursuant to all the laws of the State of Minnesota and regulation as <br />the �����=v`�S 4f tl�e City of Roseville may from time to time �sres �� u [�i� Minnesoka Statue �1 �� l��. . � <br />Signature ` � �- � ��� ��� ��� � � <br />�ate <br />�������� �'` � _ _�_ l- - <br />If completed license should be mailed somewhere other than the business address, please advise. <br />