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Fa all munMod business license questlons, contact: ❑W of $own Bend • Department of Community Investment <br />227 West Jefferson Bhd • 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 />III. OWNERSHIP <br />A. Type of ownership (check one): <br />■ .Sole Proprietorship (If sole proprietorship, proceed to 1). <br />Partnership (If partnership, proceed to2). <br />Corporation (If corporation, proceed to 3). <br />1. Sole Proprietor <br />Name:AlySS2 RIGS <br />Residential Address: - <br />city -South Bend state -IN Zip, 46614 <br />2. Partnership (List at least two (2) partners) <br />Name#1: <br />Residential Address: <br />City: State: Zip: <br />Name #2: <br />Residential Address: <br />City: State: Zip: <br />3. Corporation <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: Zip: <br />Residential Address: <br />City: State: Zip: <br />Name#2: <br />Title: <br />Business Address: <br />City: State: Zlp: <br />Residential Address: <br />City: State: Zip: <br />2 <br />