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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 S -South Bend, Indiana 46601 • 574.235 5912 • F: 574.235,9021 <br />LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY <br />MUNICIPAL CODE SECTION - 4-39 <br />III. PERSONAL DATA <br />A. Applicant's Legal Name: <br />B. Residential Address: <br />City: <br />C. Residential Telephone Number: <br />D. Residential Fax Number: <br />E. Cellphone Number: <br />F. Position with Business: <br />State: ...�_�........�_ ... v .21p: <br />IV, OWNERSHIP <br />A. Type of ownership (check one): <br />..............._....., .,...,_.. Sole Proprietorship (If sole proprietorship, proceed to 1). <br />....... Partnership (If partnership, proceed to 2). <br />X <br />.�,,�...�.,���,., Corporation (If corporation, proceed to 3). <br />1. Sole Proprietor <br />Name: <br />Residential Address: <br />State: <br />City: <br />te:.........�._.�..�..........���...�......w...�� <br />Telephone Number: <br />2. Partnership (List at least two (2) partners) <br />Name #1: <br />Residential Address:. <br />City' <br />Telephone Number: <br />Name #2: <br />Residential Address.;. <br />City <br />Telephone Number: <br />p <br />State:--,", ­...­ ....-...,Zip: <br />3. Corporation <br />Legal name of corporation:, <br />MEMORIAL HOSPITAL OF SOUTH BEND, INC. <br />eye <br />�R .....�x...�._we�� .._ . �,..,_ ...._ <br />Date and state of incorporation: OCTOBE311985 <br />....................................... <br />2 <br />