Massage Establishment - Southside Massage Retreat

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For ali municipal business license questions, contact: City of South Bend -Department of Community Investment 227 West Jefferson Blvd - Suite 1400 S •South Bend, Indiana 46601 •574.235,5912 o F: 574.23M021 LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION - 4-35 Ill. OWNERSHIP A. Type of owners ip (check one): Sale Proprietorship (If sole proprietorship, proceed to 1). Partnership (If partnership, proceed to 2). Corporation (if corporation, proceed to 3). 1. Sole Proprietor Name: Residential Address: \�c City: _��`�� State: Zip: 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: Name #2: Residential Address: City: 3. Corporation State: State: Legal name of corporation: Date and state of incorporation: List officers and directors who own 15% or more of stock: Name #1: Title: Business Address: City: State: Residential Address: City: State: Name #2: Title: Business Address: City: Residential Address: City: State: _ State: 2 Zip: Zip: Zip: Zip: Zip: Zip: