90-979 V 1 ���� i Y� !_. Council File # �
Green Sheet # 5684
RESOLUTION �� �
ITY OF SAINT PAUL, MINNESOTA ��,����,.�'
�.�
;�
Presented By �� -(�"�% �
Referred To Co ' tee: Date
RESOLVED: That application ID��66298 for a Massage Therapist License
by Kathryn E. Roe DBA Janos Takacs Eurpoean Theraputic
Sports Massage Center at 1619 Dayton Avenue, be and the
same is hereby approved.
� Navs Absent Requested by Department of:
zmon
osw
on �— 7.;�enG�and Permit Division
acc ee — � - - - -
e man "�—
une �—
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Adopted by Council: Date JU N � �9� Form Approved by City Attorney
Adoption Certified by Council Secretary By: ���l��
r �
By° "� Approved b Ma or for Submission to
Y Y
Approved by Mayor: Date 7 ,�
ncil
BY� /%i!�°��,�l.� By�
PUBUS�EQ J UN 16 1990
NOTE: COMPLETE DIRECTION3 ARE INq.UDED IN THE(iREEN 3HEET INSTRUCTIONAL
MANUAL AVAILABLE IN THE PURCHASINCa OFFICE(PHONE NO. 298-4225).
ROUTING ORDER:
Below are preferred routlngs for the five most frequent types of documeMs:
CONTRACTS (assun►sa authorized OOUNGL RESOLUTION (Amend, BdptsJ
budpet exista) Acoept.Grants)
1. Outside Agency 1. Department Director
2. Initiating�spartment 2. Budget Direator
3. City Attomey 3. Gty Attomey
4. Mayor 4. Mayor/Aseistant
5. Finarxs d�Mgmt Svcs. Diractor 5. City Council
8. Flnance AccouMing 6. Chief AccouMaM, Fln b Mgmt Svca.
ADMINISTRATIVE.ORDER (Budget COUNCIL RESOLUTION (ail others)
Rsvision) and ORDINANCE
�, q���,M��� 1. tMtiating DspartmeM Director
2. Department AccountaM 2. Gty Attomey
3. DepaRment Diroctor 3. MayoNAasistant
4. Budget Diredor 4. Gty CoUncil
5. City Clerk
6. Chief AxouMant, Fln 8 Nlpmt Svcs.
ADMINISTRATIVE ORDERS (all�hers)
1. Initiating Depertment
2. City Attomey
3. MayodAssistant
4. City Clerk
TOTAL NUMBER OF 3KiNATURE PAOE3
Indicate the A�of pa�sa on wf�Ch sfynatures are requlred and pa�ercilp
�h of these�
ACTION REOUE8TED
Dsscribe what the projsct/roquset seeks to accomplfeh in eithsr chronologl-
cal ordsr or order of importance,whichsver is moat appropriate for the
fssue. Do not wAte canpl�e aentences. Be�n each item in your Nst with
a verb.
RECOMMENDATION3
Complete ff the fssus in qusstion has been presented before anY�Y� Public
or private.
SUPPORTS WHICH (AUNqL OBJECTIVE7
�ndkate wnicl, cou�a��thre(s)yau pro�ecvrequeas suppor�s br���inp
the ksy virord(s)(HOUSIN(3, RE(�iEATION, NEI(iHBORHOODS, ECONOMIC DEVELOPMENT,
BUD(3ET,SEWER SEPARATION). (3EE COAAPLETE LI3T IN IN3TRUCTIONAL MANUAL.) •
OOUNGL COMMITTEEIRESEARCH REPORT-OPTIONAL AS REQUESTED BY COUNCIL
INITIATING PROBLEM,13SUE,OPPORTUNITY
Ex�ain the situation or oonditfons that created a need for your project �
or request.
ADVANTAC3ES IF APPROVED
Ind�ate whether this is simply an annual budpst procedure raquired by law/ �
charter or whethsr thers are epeciflc wa in which the City of Saint Paul
and ita citizans wiil beneflt from this pro�ect/actfon.
DISADVANTAGES IF APPROVED •
What negativs effeats w major changes to sxisting or p�st proceae�might
this projectlroqusst produce H it fs passed(s.p.,trafflc dslays, noiae,
tax increases or eseessrtienta)?To Whom?When? For how bng?
DISADVANTAGE3 IF NOT APPROVED
Whet will be ths negative conaequences if ths promised action is not
approved?Inabiliy to deliver serviceZ ConUnued high traffic, noise,
accident rete?Loss of revsnue?
FINANCIAL IMPACT
ARhough you must tailor the information you provide here to the issue you
are addresain�, in general you must anawer two questions: How much is it
going to coat?Who ia gang to pay4 .
. -� �=yo �,�
UIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE �� � / � �L
INTERDF.PARTMEh'TAL REVIEW CHECKLIST A.ppn Processed/Received by
Lic Enf Aud
Applicant ��� ��V} C�. ��b-Q� _ Home Address�}�� y�� LSC,-�--�j �� ��
Bus ine s s Name�� �S��G '(��,�n� �,�) Home Phone ��- y3 yr�
��`, ,�,�. �t-�s cz�,�.�L�o�r "
usznes �ddress �(� � a��-}bn-� � Type of License(s) � ;
Business Phone � - �p�
�
Public Hearing Date � � License I.D. �� -��
at 9:00 a.m. in the Counc Chambers,
3rd floor City Hall and Courthouse State Tax I.D. 4� pZ � �j�j � x(p
llate Nutice Sent; Dealer �� � t�'r
to Applicant
I'ederal Firearms 4� � �
Public He-aring
DATE INSPECTIUN
REVtEW VEKFIED (COMPUTER) COMMENTS
A proved Not A roved
Bldg I & D I
5� 3 �
��
Health Divn. � I '
3 '
� 6
�
Fire Dept. � -
i _
i I LV I �--� �-
�
Police Dept. ( I I
�I ► `6 �
� �
License Divn. �
i
��I �� ' � .
City Attorney � �
� �� � p �,
Date Received:
Site Plan � '�
To Council Research
Lease or Letter Date
from Landlord _� ��
CURRENT INFORMATION NEW INFOItMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Currer.t Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
` �--
�, . �yp-l�j 7�
.. , CITY OF S'i'. PALTI,
DEPARTMENT OF FINANCE AND MANAGENIENT SERVICES
LICENSE AND PERMIT DIVISION
Please answer a11 questions Pu].ly and completely. This applicatioa is thorough�r checked. �
Any PalsiPication will be cause Por denial.
_ _ - ± � Date � r l � _19��_O„ •
1. Applicatioa for /`v�"�S �� ����'�IS � (Licease)�Permf.t) `�
2. Name of appl.icaat K�"T�-'le-`E !J � 1Q(J C
3. If applicant is/has been a married female, list maiden name �
. ��,.�-4Z
k. Date of birth Age�Place of birth �� ���- ��
5. Are you a citizen of the United States�Native Naturalized
6. Are you a registered voter�_Where GUW�•w� ����'��w�
ss� �� �,Zr
7. Home Address �'�' �/� 13� •1-SG�itX`c ' �� Home Telephone yy k ��7 3 9�
8. Present business address �� � °� ba<�'(�fi.� . S'�'� Pa^-�- Business Telephone hh�'ioo�
9. Including your present business/employment, what business/employment have you
followed for the past five years. �
Business/employment. � Addres ���� �os�' C��fi��--
/✓l p�S
�.,5, ���.� �-� r��w l5 �w� S s'�° �
r ��5'— ��.� .
10. Married_N�if ansWer is "yes", list name and adciress of spouse
11. If this application is for a Massage Therapist License, Iist time so occupied.
Years Months.
12. Have you ever been axrested `��5 . If answer is "yes", list dates of arrests, Where,
charges convictions and seateaces.
Date of arrest 'F�• 19�_�ere L� 1�rv�c�� < <-l�'
Charge D 'ffL -
Coavictioa �GS Seatence N� , F� n'e—
Date oP arrest 19 �ere _
Charge
Conviction Sentence
_ � � � � � ��-��9
13. Give names and addresses of two persons, residents oP St. Paul, Minnesota who can
give information concerning you.
� NANIE . ADDRESS
_ ��. V d,.�, I � %�- �l�1 1.�-�io��- I Qo c� "� �t�� �t- z; o L ss���%�
�� K��y. .. 2o g �1�.._ f�-e. 1�0, i�So Z.
State of Minnesota )
) ss y�6�'�1 E — �t2C �f
County of Ramsey ) �
�C�.`CY�r �l Yl �- -� c,�� being first duly sworn, deposes and says upon oath
that he as read the foregoing statement bearing his signature and knows the contents
thereof, a.nd that the same 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 � `"�
gnature of Applicant
this � day of -�_19 C1 D
�. ��( --� ��
1 Y\/` ���i1 -1 � ✓ % 7. . ��)..n� ` "'— A lt
Notary Public,,�� County, Minnesota f`".�1 KRISiiNA l.VAN NORN �
�� `' � '��NOTARY PUBLIC—MINNESOTA
���1
r'(y Commission expire��., -o�. ICt�'(o� �-y DAKOTACOUNTY
�J 'Ay i;ommission Expires Jan. 2. 1°92 �
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