89-891 WHITE - GITV CLEAK
PINK - FINANCE COl1IIC11 /�/1,��/f
BI.UERV - MAVORTMENT GITY O SAINT PAUL File NO• � � •/
, Coun 'l Resolution �� ,
Presented By '�°���`�" '
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (I #90148) for a Massage Therapist License
by Nicholas Medw'd BA Sr. Rosalind Professional Massage Center
at 734 Grand Ave ue, be and the same is hereby approved.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
Lo� In av r
Goswitz
�i /r� B
Sc6eibel �/ _ A ga n s t Y
Sonnen
Wilson
MpY 1 81 Form Appr ved by City Attorney
Adopted by Council: Date - - //� �j
� O/
Certified � sed by Council Sec etary By
.
B ,
ppro b Mavor. Date
�Y � Approved by Mayor for Submission to Council
By
l��.sgn- ' +r,f `: i� �,
�2�f4�i� �!i lJ � ri..
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DEPARTAAENT/OFFlCE/COUNqL DATE IN �o � 7 5 7
Fi nance/�i cense GREEN SHEET No.
CONTACT PERSON 8 PHONE �DEPARTMENT DIRECTOR INITIAU DATE ❑CITY COUNpI INITIAL/DATE
Kri s VanHorn/298-5056 "�" � [i]cmr nrro�ev m cm c�wc
MUST BE ON COUNCIL AOENDA BY(DAl'� AOU71 �BUDOET�RECTOR �FIN.a M(iT.SERVICES DIR.
5-18-89 �MAYOR(OR ASSISTANT) [� '1 R
TOTAL#�OF SIGNATURE PAGES (CLIP A L L ATION8 FOR SIQNATUR�
ACiION REQUESTED:
Application for a Massage T er pist License.
Notification Date: 5-1-89 Hearin Date: 5-18-89
RECOMMENDATIONS:Apqow py a RsJsct(R) COUN CO MITTEEIi�SEARCH REPORT OPTIONAL
_PUINNINO COMMISSION _pVIL SERVICE COMMIS810N ANALY PHONE NO.
_qB COMMITTEE _
OOMME .
_3TI1FF —
—DI8TRICT COURT _
SUPPORTS WHICH COUNGL OBJECTIVE?
INITIATINK�PROBLEM,ISBUE.OPPORTUNITY(Who.Whet.When,Where,Wh�:
Nicholas Medwid requests C un il approval of his application for a
Massage Therapist License BA Sr. Rosalind Professional Massage Center
at 734 Grand Avenue.
ADVANTA(iES IF APPROVED:
DISADVANTAOES IF APPROVED:
DISADVANTA(�ES IF NOT APPROVED:
C��:rc�1 Research Center.
�r°jAY 0 9 i��9
TOTAL AMOUNT OF TRANSACTION a COST/REVENUE BUDOETED(CIRCLE ONE� YE8 NO
FUNDINO SOURCE ACTIVITY NUM�R
FlNANpAL INFORAMTION:(EXPWN)
., � . � � q- � 1��
DiVISIQN OF LICENSE AN1) PERMIT ADMIN ST TION llATE /
INTERDF.PARTME1�TAi, REVIEW CHECKLIST A.ppn Processed/Received by
Lic Enf Aud
Applicant ���,�� ���5 ���,��_ Home Address �(� 5'D� �GQCti l.t��Q�l oZ��
��n�n��sn�i�-
Business I3ame � Home Phone �-y�-- Up��
Business Address 1 I� - Type of License(s) m�`S���r�,-� '
Business Phone ��- �S�l 1
Public Hearing Date 5 � License I.D. 41 �(�1� �
at 9:00 a.m. in the Council C amber ,
3rd floor City Hall and Courthouse State Tax I.D. �� O�S 3 j a,� �
llate Notice Sent; � I �l� o Dealer 4� {� � .q
to Applicant
I'ederal Pirearms 4� (� ��
Public Hearing
DATE I SP 'TIUN
REVIEW VERFIED (G UTER) CUMMENTS
A proved N t A roved
Bldg I & D ,I
r1 � �S
��
Health Divn.
� a�
� l-�
I � �
Fire Dept.
; as � 6�,
�
, �
Police Dept. �la� I
�
License Divn. � �
i ��
as �
City Attorney �
��� ' �k
Date Received
Site Plan
To Council P.esearch ���' ��j
Lease or Letter �'�r Date
from Landlord
'" , ' • ' CI Y F S'i. PAUL
' DEPARTMENT OF FI AN E AND MANAGEI�NT SERVICES
LICENSE A PERMIT DIVISION
Please answer all questions fully and c mp etely. Th�s application is thorough� checked.
Any falsification �rill be cause for den al
, Date�gr 2� 19�
1". Application for �/��Q'-fJ/�'GC /� /� /S� �License)�Permit)
2. Name of applicant �/�/i��7o��+ J' 4'E(Jl��C
3. If applicant is/has been a married em e, list maiden name�A
P ac of birth�"��n,.�'��f�^-� � ✓VP�v i�''e�
4. Date of birth// .2 5 Age �� �� � �
5. Are you a citizen of the United St es S Native Naturalized
6. Are you a registered voter .� o er
n / /�7ii7/l t'i GAJ.Ch,
7. FIome Address /GSG�[�cjQiz�iI ��Y 2 �:3 Home Teiephone 5�3'OC��
8. Present business address �t- �'� Business Telephone ,'G'/,�_
9. Including yovr present business/em lo ent, what business/employment have you
followed for the past five yeaxs.
3usiness/employment. Address
�� ,S ✓�/��lG:��c s�t'��/G �li ri ��/ac c; ' ����, i�� Il 7S 3
m�SS��f• T`l�r�a��_.<7�
JYI�Sl�q�' T�/�� l C���rlc� r-rra<�,��ryfzricrn . :' -G�/05y'/
10. Married PS if answer is "yes", is nacie and address of spouse
/ t',�o�2FS h' -� �Q/)�� CI� r s
11. If this application is for a M ass ge Therapist License, list time so occupied.
/ .�i eaxs Months.
12. Have you ever been arrested ; � I answer is "yes", list dates of arrests, where,
chaxges convictions and sentence .
Date of arrest 19 er
Chaxge
Conviction Sentence _
Date of arrest 19 �ere .
Chaxge
Conviction Ser.tence
. . � .
,- � � , .
13. Give nam.es a.nd addresses of two per ons, residents of St. Paul, Minnesota �rno ca�
give information ccncerning ;�ou.
:VAI� ADDRESS
r/I •"�u � � . y�� �l��T PP�e�/,� �J� V�. ✓�1Cc./
i('� �os.��i�c+� � � 73� ^ f,►�vc� ,'�vf- ul f: /Q<<�
State of :�innesota )
) SS
County of Ransey )
�� ,L,�c.�11 (.� � 4Y `� (kiwi C� bei g �'rst duly sworn, deposes ar.d sa�s �ipon oath
that he has read the foregoing statement be ing h�s signature and knows the cor.tents
the:eof, and that the sa:ue is true of hi o knowledge except as �o those mat�ers
therein stated u�on infor�ation and beli f d as to those matters he believes them
to be true.
, �
Subscribed and sworn to before ne ?� �..C..GG�J� _
Signature of Applicant
th'-° �� day of �l' .� 19�_ .
, y ._ �L l�_ l� � � /
^totary Public, Ra�e�ey County, ?�Iinneso�a �������AN HORN
���NOTARY PUBLIC—MINNESOTA �
D,�-(wt�.— �
sl�.• �A!sOTA COUP�Tr
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