HomeMy WebLinkAbout3C - Massage Therapy License Dorothy Kirschner
INTER-OFFICE MEMO
TO:
FROM:
RE:
DATE:
PRIOR CITY COUNCIL/KAY KUHLMAN
LAURIE DAVIS/LICENSE CLERK
MASSAGE THERAPY LICENSE RENEWAL
FEBRUARY 1, 1993
Attached is an application from Dorothy Kirschner for renewal of
her Massage Therapy License. Ms. Kirschner ~ractices massage
therapy at the Hair Mate Beauty Salon in Pr10r Lake. Also
attached is a receipt for the license fee and the general
corporate license which will need Kay Kuhlman'S signature upon
approval.
Please return to me pending approval.
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No. / $~
GENERAL CORPORATE LICENSE
STATB OF MINNBSOTA
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P'OI'U.1 IJl}i BU~INESS RECORDS CORPORA TlON M.NNESOT A
RECEIPT
DATE
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No20302
CITY OF
PRIOR LAKE
4629 DAKOTA STREET S.E., PRIOR lAKE, MN 553n
Received of .f1.1~ M~
whose address and/or leg~ de~cription is
the sum of
/aJcg
dollars
for the purpose of
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Reference Invoice No.
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Receipt Clerk for the City of Prior Lake
Provide the names, residence and business address of three (3)
residents of Scott county, of good moral character, not related
to you or financially interested in the premises or business, who
may be referred to as to your character:
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Signa ure 0 App cant
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Date I
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CITY or PRIOR LAD
RENEWAL APPLICATION rOR PERSONAL SERVICE LICENSE
PRACTICE or MASSAGE
NAMI! Iifrrr# (.~'Il.)
ADDRESS / dcO It STA :PI(; II P'
PHONE NUMBER0t_9j9 Y - '13/0 CITIZEN OF U. S.? YES Y- NO _
PLACE OF BIRTH I...ETCHi:.~ 5, I::> DATE OF BIRTH C, -.s-. 3 I
J('~J-ItUEP
as
Have you ever POsed or been known by a name other than your true
name? ~ If yes, give name(s), date(s) and
place(s) where used.
The name of the business if it is to be conducted under a
designation, name or style other than the full and individual
name of the applicant
(If business name is used a copy of the certificate is required
by M.S.A. Chapter 333, certified by the Clerk of the District
Court, shall be attached the the application.
Address(s) during the preceding five (5) years
~AmE
Names, locations and type of business or
been engaged in during the(prec d~ng fi
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Names and addresses of your emp~ers and
the preceding five (5) years ~Je-
occupations
( 5) .y"rs
~ IlJ
you
have
partners, if any, for
Have you ever been convicted of any felony or crime? Alo
If yes, give the time, place and offense for which conviction(s)
were had
~
List the names
for you
of those individuals to be licensed and working
-'
Are you licensed in~th~f/communities to run similar business__
If yes, where ~15U ~ II / L L e IJ) IL/
,
Have you been denied a massage or sauna license previoUSlY?~
If yes, please explain situation