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ES. l <br />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 46601 - 574.235.5912 - F: 574.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />111. OWNLRSHIP <br />A. Type of ownership (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 5 <br />Name: <br />Residential Address: <br />City: i✓�� �c� State: �~ 1 <br />2. Partnership (List at least two (2) partners) <br />Name #1: <br />Residential Address: <br />City: <br />State: <br />.................. <br />Name #2: <br />Residential Address: <br />City: <br />3, Corporation <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 />City: <br />Residential'Address: <br />City: <br />2 <br />Zip: L)& t -7 <br />Zip: <br />M. <br />0 <br />State: zip: <br />State: <br />Zip: <br />