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For all municipal business license questions, contact: City of South Bend • Department of Community investment <br />227 West Jefferson Blvd a Suite 1400 5 -South Bend, Indiana 46601 a 574.235.5917 o F: 574.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-3S <br />11), OWNERSH)P <br />A. Type of ownership (check one): <br />x Sole Proprietorship (if sole proprietorship, proceed to 1). <br />Partnership (if partnership, proceed to 2). <br />Corporation (if corporation, proceed to 3). <br />1. Sale Proprietor <br />Name: Dena M. Woods <br />Residential Address, 20807 Wellesley Ct. <br />city: South Bend State: IN Zip: 43637 <br />2. Partnership (List at least two (2) partners) <br />Name #1: <br />Residential Address: <br />City: <br />Dame #2: <br />Residential Address: <br />City: <br />3. Corporation <br />State: Zip: <br />State: Zip: <br />Legal name of corporation: South Bend Massage, LLC <br />Date and state of incorporation: 1 /1 /18 <br />List officers and directors who own 15% or more of stock: <br />Name #1: <br />Title: <br />Business Address: <br />City: <br />Residential Address: <br />State: Zip: <br />City: State: <br />Name #2: <br />Title: <br />Business Address: <br />City: <br />Residential Address: <br />City: <br />V <br />Zip: <br />State: Zip: <br />State: <br />Zip: <br />