90-440 OR I r� � (,� � Council File # -y-�d
1 � �/ /-1
Green Sheet # 7761
RESOLUTION �
CITY OF SAINT PAUL, MINNE TA � �-rj
� ---
:
Presented By � �
Referred To Committee: Date
RESOLVED: That application ID4�73531 for a Massage Therapist License
by Teresa M. Helmberger at 324 Johnson Parkway (Parkway
Ma.nor Health Care Center) , be and the same is hereby
approved.
Y�e „� Navs Absent Requested by Department of:
zmon
sw �-
on —T License and Permit Division
� acca ee —
e man �-
u e �—
z son r By:
Adopted by Council: Date MAR 2 0 1990 Form Approved by City Attorney
Adoption Certified by Council Secretary By: 2"27�f�
BY' 'L , �e�C�d?� Approved by Mayor for Submission to
Approved by Mayor: Date 2
� Council
By: � � By'
PlIBtISHED i`�,r-',� �� 1 0_
. . ,. � . �"i��a
DEPARTMENT/OFFICE/COUNCII DATE INYfiATED i�
Finance and Mana ement GREEN SHEET NO. �7�1'
CONTACT PER30N 6 PHONE INITIALI DATE 1 AUDATE
�DEPARTMENT DIRECTOR �GTY COUNGL
Kris Van Horn - 298-5056 �� �CITY ATTORNEY �CITY CLERK
MUBT BE ON COUNdL AOENDA BY(DATE) ROUi1N0 �BUDOET DIRECTOR �FIN.8 MOT.SERVICES DIR.
March 15 1 0 ❑MAY������ OCouncil Resea ch
TOTAL N OF SIQNATURE PAGES (CLIP ALL LOCATION8 FOR 810NATUR�
REOUESTED:
Application ID4�73531 for a Ma.ssage Therapist license.
REOOMAAENDATION8:APD►ow(A)c►Reject(R) (�{p�qL RC,l1 REPORT OPTIONAL
_PLANNINO COMM18810N _dVll SERVIC�O�AMISSION ��� P�E�.
_qB OOMMITfEE _
—3TAFF _ OOMMENT8:
_DISTAIC'T OOURT _
SUPPORTS WFIICN WIJNqI OBJECTIVE?
INI?IATINO PROBLEM.ISSUE.OPPORTUNITY pMa.Wh�t,WINn,Whsro.Why):
Teresa M. Helmberger requests council approval of her application
for a Massage Therapist license at Parkway Manor Health Care Center
at 324 Johnson Parkway. All fees and applications have been submitted
all required departments have reviewed and approved this application.
a.
ADVANTACiES IF APPROVED:
D18ADVANTAOE8 IF APPROVED:
WSADVANTAOES IF NOT APPHOVED:
RECEivFn
�R121�O t�ouric�� M���?�cn t;enter,
Grr�3 G!��x �v�N� u� ��yo
TOTAL AMOUNT OF TRANSACTION = C08T/REVENUE BUDGETED(qRC.LE OI�) YE8 NO
FUNDINO SOURCE ACTIVITY NUM�R
FlNANCIAL INFORMATION:(EXPLAIN)
dw
� � � � � �f�-" 90�6
DiVISION OF LICENSE ANI) PERMIT t1DMINISTRATION DATE � � 'l � / /-r (�
INTERDF.PARTMF.NTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant �ec,l��. t-� ►-y��� Home Address �5 , y�So- ��c�v •�
�—
Business Namee�G.(��(�.�J ! ►1�;1n(}� �-+'hCuYi°�Iome Phone `�1 �- �C���
—� �:�.
Business Address ����_t.� �+p� �{ k�. TYPe of License(s) �(nSGC��rf�c�'�
____��.
Business Phone ''��c-�- �'y`�3'7�P
Public Hearing Date ''i��,�,�,� ��('� License I.D. �l �� �3 5 3�
at 9:00 a.m. in the Council Chambers, �/
3rd floor City Aall and Courthouse State Tax I.D. 4t �-���°�� �S
llate Nutice Sent; Dealer �� 1� �Pt
to Applicant ���� < < �1C� � I �
Federal Firearms ��
,-
Public Hc:aring
DATE IrSPECTIUN
REVIEW VERFIED (COMPUTER) CUMMENTS
Ap roved Not A roved
�
Bldg I & D � �
/z� �
�
Health Divn. , /� '
;,
�� ' o �
�
Fire Dept. '� � ` ` (1
! ,r� T �,�L
j � w
I �
Police Dept. '
\ � � �� � r�.
, + i`
�. 1
License Divn. �/ ,
� � ' C��
City Attorney �a 1 �
� ��
Date Received:
Site Plan ��(k
To Council Research
Lease or Letter Date
f rom Landlord ��(k
CURRENT INFORMATION NEW INFORMATION
Current Gorporation Name: New Corporation Name:
Current DBA: New DBA:
Currer.t Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
DEPARTI�NT OF FINANCE AND HANAGII�NT SERVICES n
. • , LICENSE AND PERMIT DMSION �'�Q��/
Please answer a11 questions fully aad completely. This applicatioa is thorough� checked.
Any Yalsification will be cause Por denial.
, Date / — / / 19,�,�,,,
1. Application Por icense Permit)
`�
2. Neme of applica.nt Q-- �
3. If applicsnt /ha.s been a married female, list maiden name � C� �w � Y ��.�'i
4, Date of birth - - Age��Place of birth ��,.��,U, �.�.�. ���
5. Are you a citizen oP the United States�Native Naturalized
6. Are you a registered voter Where � Ya-�
�
7. Home Address Home Telephone -
S. Present business address�,�. Business Telephone�7� '9 7 3 7
9. Including your present business/ oyme , What bus ness/ ploymen have you
followed for the past five years.
Business/employment. Address
�1/l s ' �I���,n 1� _ - st .
10. Married if answer is "yes", list neme and address of spouse �,��±-Yw��'`�`�
0
5 �
11. IP this appli ation is for a Me.ssa8e erapist License, Iist time so occupied.
ears -_- Months.
12. �ave you ever een arrested /�,�5_If ansxer is "yes", list dates of arrests, vrhere,
charges convictions and sentences.
Date of arrest 19 Where
Charge
Conviction Sentence
Date of arrest 19 Where
Chaxge
Conviction Seatence
. . . . , ��o -��1°
13• Give names and addresses of two persons, residents of St. Paul, Minnesota who can
give information concerning you.
NpME , ADDRESS
�v �,� �. ��.,r�1i+t? . ,.��
Uo�.
�
i.v / z y 7 . • o..,J�L�c..
State of Minnesota )
) SS
County of Ramsey )
being first duly sworn, deposes and says upon oath
that he has read the foregoing statement beaxing his signature and knows the contents
thereof, a.nd that the sa.me is true of his own knowledge except as to those matters
therein stated upon information and belief and as to those matters he believes them
to be true.
Subscribed and sworn to before me �
ignature of Appli nt
this 1. � day of 19�_
Cl.�.� �t-�--�—�— � -
Not r Public .�eey County, Minnesota ,�nnn,�,�n�
y ' y�,�.L,� �rc'y�".�"� KRISTINA L.VAN HOftN �
D Commission expires p� 1�(� 1.'���TARYPUBLIC—MINNESOTa
� �AKOTA GOUNTY ��
MY Commission Expires Jan. 2, :;;y:: j
w�v�+wvrnnnnn tiv+n.��;