87-449 WHITE - C�TV CLERK
PINK - FINANCE GITY OF SAINT PAUL Council
CANARV - DEPARTMENT
BIUE - MAVOR � Flle NO. �����
Cou� il e lu ion
Presented By '
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D.#40398) for a Massage Therapist License applied
for by Mary T. Heimel DBA Professional Massage Center at 734 Grand
Avenue, be and the same is hereby approved.
COUNC[LME(V Requested by Department of:
Yeas Drew Nays � -
Nicosia ln Favor
Rettman
Scheibel �
Sonnen __ AgainSt BY
�edeoco
Wilson
Adopted by Council: Date ��� 8 - 1g87 Form Appro e by City Att ney
Certified Va•s d y ouncil S tar BY
gS,
Approved by Mavo : �— `��' I � �' � �'�r� APP�ove y Mayor for Submission to Council
�
BY - �— BY
�i�i�,�� , .. �. i u 1987
, (;/— �f�-�7�
� ` � CITY OF S'l. PAUL
DEPARTMENT OF FINAPJCE AND MANAGEMENT SERVICES
LICENSE AND PERMIT DIVISION
Please answer all questions fully and completely. This application is thoroughly checked.
Any falsification will be cause for denial.
� � � 19
� Date �i ` �
1. Application for /� � � '' ����� � �- << � '� '' " - (License)(Permit)
�
�,
2. Name of applicant / '- ' �'''-
3. If applicant is/has been a married female, list maiden name �
�
4. Date of birth � � � % Age '' ( Place of birth �� j �. ���'�! ��`� _ �
5. Are you a citizen of the United States Native Naturalized
r i . �l. f� �!,r;
6. Are you a registered voter Where '� ' "` �
7. Home Address � � ` � '��� � `��� l�_�� � ' ,�_ Home Telephone �, � �� � � ''1
8. Present business address �',�..!�� �� � �`�'t )� I r`,'' � Business Telephone �-� � � ' % � ��
9. Including your present business/employment, what business/employment have ,you
followed for the past five years.
Business/employment, Address
��
;
� i ,, � � � ;� _, � � ;.
10. Married if answer is "yes", list name and address of spouse __
11. If this application is for a M assage Therapist License, list time so occupied.
i
Years Months.
12. Have you ever been arrested r � , If answer is "yes" , list dates of arrests , where,
charges convictions and sentences.
Date of arrest 19 Where -
Charge
Conviction Sentence
Date of arrest 19 �ere
Charge
Conviction Sentence
. � � � . � ����`��__
L'. Give names and addresses of ;:wo persons , residents of ��t. Paul, Minr�esota w:�o can
gi�re infor:nation concerning fou.
iuArJIE ADDRESS
�i_1��� � �.� ;�� �,� ' � � � � � i[ �� ,� l �` . ' ���"� ��;.,�� i��Uuc _ lt �'�� � �,i.l �
) i
,
����,�l�i ,��;�t� "�"� /� � �: i ii / ;c. `�f ��.tl.�:_
Siate of Minnesota )
� SJ !f I , �� _ ,- ��' ..
Count;� of Rar.isey )
�._--
� , °�, � �� �-C�.i_-,-��k��_.����being first duly sworr., deposes and s�.ys upon oath
that� he ;'.'i read the °oregoing state�ent bearing his si�na'�are and kr.ows the conter.i;s
thereof;, and that the sa��e is true o�" his own knowledge except as to those matters
therein stated upon in°or�ation and belief and as to those matters he belie�✓es them
to be true.
i
Subscribed and sworr}'t before me ____���� �-� �� � ;� � j; ;�-�
�� , ', -7� �,, _i�Signature of Applicanti
��r i��?' day, o f �.�% 19�
,��� - � �' 'l_�- .��� ,�_ ��,
;�?o�a y ublic , Ra.�sey Cour.ty, Minne�ota' __
�*rrs*aa=a�y�:o�.�r c�+,t�,. .
�•+�� i�ommission expires � �: �':� -�. „ ,'.';�.;_!!`•.'ti�rii
'� :�'. ' ,, �S
ti ':•� S
� >
h....n :r �