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For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46501 • 574.235.5912 • F: 574.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III. OWNERSHIP <br />A. Type of owners p (check one): <br />Sole Proprietorship. (If sole proprietorship, proceed to 1). <br />Partnership (If partnership, proceed to 2). <br />Corporation (If corporation, proceed to 3). <br />1. Sole Proprietor <br />Name: SA(?_14 _�,)OS X-�P_ h"Z.it <br />Residential Address: R)-ks�ts 2 <br />City: State: \ N Zip: AyD � <br />2. Partnership (List at least two (2) partners) <br />Name #1: <br />Residential Address: <br />City: <br />Name #2: <br />Residential Address: <br />City: <br />3. Corporation <br />State: <br />State: <br />Legal name of corporation: <br />Date and state of incorporation: <br />List officers and directors who own 15% or more of stock: <br />Name #1: <br />Title: <br />Business Address: <br />City: State: <br />Residential Address: <br />City: State: _ <br />Name #2: <br />Title: <br />Business Address: <br />Citv: <br />Residential Address: <br />City: <br />Zip: <br />Zip: <br />FE <br />Zip: <br />State: Zip: <br />State: <br />FZ. <br />2 <br />