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18. Are you directly or indirectly interested in other establishments in the Ciyj of Little Canada to <br />which a license of the same kind has been issued? Yes V No <br />19. I -Iave you had any previous massage therapist license that was revoked, suspended, or not <br />renewed? Yes ✓ No <br />If yes, explain in detail: <br />20. , Have you ever made'apphcatiol for a massage therapist license or similar activity and had <br />.sueh application denied?° • -_ Yes No <br />If yes, explain in detail: <br />I understand that the information provided in this application may be considered private or <br />confidential data. I further understand that I may not be required by taw to provide such information. <br />The purpose of providing such information is to aid the City of Little Canada in its determination on <br />my application for a permit. I acknowledge the providing, or failing to provide, such information <br />may affect the City's determination on my application. I understand this information will be made <br />available to the City of Little Canada, its City Council, agents and representatives, as well as the <br />Minnesota Department of Revenue, or any other person or entity authorized by law to receive said <br />information. I release the City of Little Canada from any and all liability for its receipt and use of <br />data received pursuant to this application. <br />STATE OF MINNESOTA ) <br />) <br />COUNTY OF ) <br />l /. , U i- i / being first duly sworn, upon his /her oath, <br />deposes and says that he /she is the person who has executed the above application, and that the <br />statements made therein are true of his /her own knowledge and belief, <br />�7 <br />10 <br />11 <br />Signature <br />Title <br />