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For all murildipa I business I cense questions, contact: City of South Bend °Department of Corn m"nity/n vestment <br />U[INSEAPPUCATONFOR-PUBLIC PARKING FACILITY <br />MUNICIPAL CODE SECTION -4-39 <br />Ill. PERSONAL DATA <br />A.Applicant's Legal Name Heather P.NuUmz <br />8.Residential Address: 15Lewis Street <br />City: Hartford State: CT Zip. 06103 <br />[. Residential Telephone Number: 800.522.7641 x7793 <br />D.Residential Fax Number: <br />E.CeUphuneNumber: <br />F. Position with Business: Corporate Compliance Officer <br />IV. OWNERSHIP <br />A.Type ofownership (check nne): <br />Sole Proprietorship (If sole proprietorship, proceed to1). <br />Comoanv Partnership (If partnership, proceed to2). <br />Corporation (if corporation, proceed tn3L <br />1. Sole Proprietor <br />Name: <br />Residential Address: <br />City: State: Zip <br />Z.Partnership (List atleast two (J)partners) <br />Nome#1: <br />Residential Address: <br />Cky� State: Zip: <br />Namp#2: <br />Residential Address: <br />3.Corpomdon <br />Legal name mfcorporation: LAZ Parking Midwest,LLC <br />Date and state ofincorporation: Connecticut ' Dec OD 2008 <br />2 <br />0 <br />