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For all municipal business license questions, comatL City of South Bend • Department Of Common" Investment <br />227 Wert Jefferson Blvd • Suite 1400 S -South Bend, Indiana 4=1.574.285.5912 • F: S74.2a5.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION -4-35 <br />III.OWNERSHIP (Continued) <br />3. Corporation (Continued) <br />Name #3: <br />Business Address: <br />Residential Address: <br />City: State: Zip: <br />IV. PERSONAL DATA <br />A. Applicant's Legal Name: Alyssa Rios <br />B. Residential Address: <br />- <br />City:South Bend State:IN Zip: 46614 <br />C. Residential Telephone Number: 5748603704 <br />D. Residential Fax Number: <br />E. Celephone Number: <br />F. E-Mail Address: arlos.crne O gmail.00rn <br />G. Position with business: CEO/Owner <br />H. Please list all criminal convictions (if any), excluding trafficviolations: <br />Nature of Conviction City State Date <br />(Attach additional sheets if necessary) <br />I. Please list all addresses for three (3) years prior to application date: <br />Street Address City State Dates <br />- South Bend IN 0812018-present <br />(A <br />J. <br />K. <br />L. <br />M <br />S7 <br />