87-718 WHITE - C�TV CLERK �
PINK - FINANCE COURCII /^�
CANARV - DEPARTMENT CITY OF SAINT PALTL File NO. U L �� .
BLUE - MAVOR
C � il R ol tion -���
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Presented By �
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Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D.#61208) for a Massage Therapist License
by Margaret Razskazoff at 734 Grand Avenue DBA Sister Rosalind's
Professional Massage Center be and the same is hereby approved.
COUNC[LMEN Requested by Department of:
Yeas Nays
DreH-
.naas���rZy�, [n F a v o r
N�cos�,-
scne�Ge.; _ ��, __ Against BY — --
Sonnen
TedesCo
y�t'� MAY 2 0 1987 Form Approv y City Attor y
Adopted by�tiuncil: Date _
Certifie a •ed by Council Secretar , BY
gy, ����"f(/C.. ' / �/
Ap rove :Navor: Date _ � � � Approved Mayor for Submission to Council
BY - — BY
/ Pi18lISHEO �`����` � 0 19 8 7
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� CITY OF ST. PAUL
. DEPAR'1'h�NT OF FINANCE AND MANAGH�4'P SI�RVICES
LICENSE AND PERMIT DIVTSIGA
These statement forma are isaued in d�nplicste. Please aasFrer all questi�na ltiilly aad
completely. This application ia thorough�y checked. Any talailication vi11 be csuie
for denial.
Dste - :ti _- 19 '�'
1. Application for ,., � . , . . - '�- (Liceaae) (Permit)
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2. Name of applicant � ' •-,� ` . ; � � , �, -. , _< _.__.
. 3. If applicant is/hsa been a me4rried Pemale, list maiden neme � i ' � '
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b. Date of birth ' ' ` Age .. Place of birth : ' - ; ! � �.
5. Are you a citizen of the United States =—Pativ�e � Faturalize8 �
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6. Are you a registered voter �" whe� t ' -
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T. Home addreas � � ' � .- •� -�:
�°, " Aame telephane � .
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B. Preaent business a,ddreas { �'' �' � ��=� . Busiaess telepbope _. `' ; '`f 5
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9. Including your present busineas/employment, What b�nsiness�e�ploqssat ha�re you�
follo�ned for the past five years.
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Business/F}nployment pddre�s
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10. Married,,,_ If ana�+�er is "yes", liat name and addresa o! spause
11. Have yw ever been arrested for an offenae that has reaulted in a coavictionl..
If answ�er is ",yes", list dates of arrests, rhere, chargee, comictions aud " �
aente�ces.
Date oi arreat 19 .�, where
CAAF.CE �%� � ' �
CONVICTION g��
Date �f arrest I9 Where
CHARGY�
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12. ' List the names and addresses (if married, name of spouse also) of all pe '
� corporations, partnerships, associations or organiZations Which in any
a. A mortgage interest in the l.icensed premise, ;�
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>b. A aecurity intereat in the licensed premises, license, or itirnishings of the �r?
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licensed premise, ' .
c. A promissory note for funds loaned for ttye aperation o! the licensed premise
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_ or the purchaee o! 'the li�cense,
d, Financielly contributed -to the purchase of the premise or the license it- �
_. . �self
e. Any other interest either direct or indirect, either financial or otherwise
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_ _..in the licensed premise or the licenae ftaelf,
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Attach �a copy hereto of any and all documents referred to in thia aftidavit.
1?. Give namea and addresses oP two persons� resideuts of St. Psul, Minnesata, who
can gim information concerning you. ! /^� �r r
� lYU'�CI � r .�� ir.�i .ar. �..f �' y-L..-1 ��Y `���+`+ S_�S M-��.._.r • �Y" O'.. .f
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14. Addreas of premises for WhSch License or Permit is made '"`+ ` � - -
Addresa Zone clsaaification
15. BetWeen what croas streets Which side of street
16. fta�ae under whf ch this business r�rill be conducted � - � ��� 9 r � `�����° ��` 1 '� '" `��'~•.'
17. Business telephone number +�` ��� � ' �' � � � "
1Q. Attach to this application, a detailed description of the design, location, and
square footage oP the premises to be licensed
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�9. ?re premises now occupied l.-''.;;,� `' What busfness� '�-'%-^�--': � Hov� long
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� !st license w�ich you currently hold, or former],y held, or me�p have an intere
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21. Have any of the licenses listed by you in No. 80 ever been revoked. Yes
N� . If anaMer is "yes",. 1ist dates and reascna; —"
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' 22. Do you have an interest of ar�y type in any ot.her businea8 or business premises.
I.° answer is "yes", list business, busineas address an8 telephone number.
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23. If business is incorporated, g�vs date of incorporation 19
and attach copy of Articles oP Incorporstion and minutes of firat meeting.
24. List all officers oP the corporation giving their names, oftice held� hame
address, and home snd businesa telephone numbera:
_�
25. If business is partnership, list partner(s) address and telephone rnimbera:
N� Addreas Tel.Fo.
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26. Is there ar�yone else who will have an interest in thia busiaeep or premiseaY
If answer is yes", give name, hcme sddreas, telephone n�bers sad in what
manner ia their interest:
27. Are yau goinR to operate this business personally �- i! aot, xho xill operste
it: .
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Aame��, A-,� ; � - ,,,,.,_i° ' � Home address i-.__ Z�el.Ao.
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. rAre you going to have a Ma.na�;er or assistant in this business? IP answer is � �
• yes , give name and ho:ne address and home telephone number:
Ng�°e Home address
Z�el.No.
29. Has anyone yau have named in questions 22 throu h 26
answer is "yes", list name of person, dates of arrest,ewhereeechargesteconvic-
tions ar,d sentence
30. I
spected by the police, fire, health and otherncitStoPficialspatmaSe � � in- _
times wt�en the business is in operation. . y �' �a all
State of ytinnesota) �
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County of Ramsey )
oath that he has read the foregoing statementsbear� 8hisnsid�oses and ssyys �pori .
contents thereof, and that the same is true of his own lmorrled�e ex 8nd ��s the
matters therein stated upon information and belieP and as to those matters he beose
lieves them to be true.
Subscribed and sworA to befoxe me �, ��,r�,.•,;�� j � f °' . .� .._ � '�,�� ,
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this r � " �� � Signature of A licaat. �� ����
a C� de�y of ' '�,� c_�i la� � ,� ,��
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Nota Pu � _ --a,l a:�. . _�_�_.�
ry bli_, „ County, Minne,sota `' �� YRtSTIpq�, S��� "^�+ti� ,
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