Laserfiche WebLink
} <br />.�4 <br />Mo sIVIEW <br />2401 Mounds View Boulevard * Mounds View MN 55112-1499 <br />(763) 717-4000 * Fax (763) 717-4019 <br />Barb.benesch(-Oci.mounds-view.mn.us * www.ci.mounds--view.mn.us <br />2020 <br />THERAPEUTIC MASSAGE <br />THERAPIST (INDIVIDUAL) LICENSE ($102 Each) <br />ENTERPRISE LICENSE ($255) <br />This is a renewal application only. The information shown below is information on your original <br />application that may change from time to time. All other information on the original application is kept <br />on file. Please review the information below, complete or make any corrections in "red" ink if possible, <br />and answer "yes or no" to any questions that are asked. <br />'WW"."M <br />Applicant Eric Rautio <br />Address 8373 Groveland Road City Mounds View <br />State Minnesota Zip 55112 <br />Phone 1 (612) 384-6045 Phone 2 /VA - <br />Email er ; C, C Q.,r�C tCO y A0-OY►'1 <br />Change in residence in the last year? <br />Convicted of a felony in the last year? <br />Have there been any changes in ownership or partnership in the last year? Nd <br />Have all real estate and personal property taxes that are due and payable for the premises been <br />paid? r 0 <br />Has the location in the building where the massage services are to be conducted changed in the last <br />year? /}Q <br />Other therapists employed (first/last names): <br />MA <br />■ If the business is to be conducted under a designated name or style other than the full individual <br />name of the applicant, attach a copy of the certification required by MS Chapter 333. <br />• Please attached or forward a valid Certificate of Insurance good through the entire license <br />period. <br />I hereby certify that the information provided I this application is true and correct and <br />understand that any misrepresentation made herein may be grounds for denial of thi, <br />application for a business license. <br />cant <br />�* �-).f <br />ZSffice Use: <br />Investigation-$50/Therapist-$102ea./Enterprise-$255 <br />Date: <br />11 <br />,PPount Paid I D Receipt <br />