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� ' � <br />� ■ �� �� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 551f3 <br />(651) 792-7032 <br />Massage Therapy Establishment License Application <br />�U��ta�G <br />��a��� ��� <br />�us�T,�,_.� }�h,arue <br />�� ����� �.�� <br />� � <br />��r� � � ��� , � � �'� �� <br />�� � � ��'����� <br />Person to Contact in Regard to Business License: <br />�7amo <br />��lcl�ss <br />�� ��� <br />4 <br />Phone ���! �� �--0_ 2 a 1' Date of Birth � <br />+,f f ■ <br />� <br />Drivers License Number <br />, -, <br />Social SecurityNumber <br />U.S.Citizen? �� _ T� <br />Naturalized? <br />�� <br />If yes, date and place: <br />� <br />� <br />�� ��� � <br />� ����s �����t <br />� _ t�l� <br />I hereby apply for i�a following license(s) for the term of one year, beginning July I, ��`�{ , and ending June <br />3 �, ���� 1, in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required Fee <br />� <br />Massage Therapy Establishment J ,`�'� � <br />. k <br />f� „ l;r�r;�.r. �,�IY3 <br />� <br />The undersigned applicant makes this applicationpursuant to all the laws of the State of Minnesotaand regulation as <br />the Council of the City of Roseville ir�zy from time to time prescribe, � auding t+ftinn�ta 5r� k��. � S�. <br />Signature <br />Date 1 �� � �— � � <br />ff completed license should be mailed somewhere other than the business address, please advise. <br />