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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 5 -South Bend, Indiana 46601 • 574.235.5912 • P 574.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III. OWNERSHIP <br />A. Type of ownership (check one): <br />Sole Proprietorship (If sale proprietorship, proceed to 1). <br />Partnership (If partnership, proceed to 2). <br />Corporation (If corporation, proceed to 3), <br />1. Sole Proprietor <br />Name: <br />Residential Address: <br />City: State: <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 />State: <br />State: <br />Zip: <br />Zip: <br />Zip: <br />3. Corporation <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: pre-_'; `el e'vi'- <br />Business Address: 6, 0;2- L,`A,. e-e) /fu Gv/v' �Fq 5f <br />City: 1r6/11_1) i, State: /, oO Zip: q& & o l <br />Residential Address: L/V,'-Ofn <br />City: It t! 'Imel'vk State:b, Zip: <br />Name#2: AA-2 _,,.��sAs'+'' <br />Title: <br />Business Address: &0,'� 4- c_e,%0 W11", S <br />City: rani` d State: 0 /� Zip: �1-&6 6) % <br />Residential Address: A3/{���/ <br />City:State: j Iy Zip:�� <br />