If you desire assistance or have questions about this form, you can email us at firstname.lastname@example.org, call us at (517) 483-4133, or visit us in the City Clerk's office, located on the 9th floor of City Hall (124 W Michigan Avenue, Lansing, MI 48933).
Complete and print this form. Bring this form and the materials listed below to the City Clerk's office to complete the application process. This form may be notarized in the City Clerk's office.
There is a non-refundable fee of $300. Proof of insurance and bond, and documentary evidence must be filed with the City Clerk at the time of application.
I do hereby make application for an exemption as a massage therapist pursuant to Chapter 822, and submit the following information:
(must be registered with County Clerk)
Have you ever been convicted of a felony or misdemeanor (other than traffic
Have you, or any business owned by you, or for whom you were employed, ever
been sued for operating or maintaining a nuisance (operating illegally?)
Are you currently a member in good standing in the
AMTA? If yes, attach documentary evidence of your membership.
Have you completed a comprehensive course of study in massage therapy at an AMT Approved
school or at a school established by legislative enactments of the State Board of Education?
By signing this application, I hereby authorize any person,
institution, or agency to provide information requested by the City bearing on my qualifications and fitness
and I RELEASE ALL LIABILITY in connection therewith.
I acknowledge by signing this application that knowing falsification shall be justification for denial of an exemption or revocation if already approved.
Subscribed and sworn to before me this ________ day of ____________________, 20_______, acting in the County of ____________________, Michigan.
Chief of Police
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