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For all inundate I business license questions, mntaR: elty of South Bend • Department of Communby Ima[ment <br />M7 West Jefferson Bbtl • Sulte 14W S •South Bend, Indiana 46601 • 574.235.5912 • F: 570.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III. OWNERSHIP <br />A. Type of owners 'p (check on <br />Sole Proprietorship (If sole proprietorship, proceed to 1). <br />Partnership (If partnership, proceed to 2). <br />Corporation (R corporation, proceed to 3). <br />1. Sole Proprietor's <br />Name: OI ' I <br />Residential Address; <br />City: .:..t.+:01 T, State:--J�Zip: <br />2. Partnership (List at least two (2) partners) <br />Name 41: <br />Residential Address: <br />City: State: Zip: <br />Name H2: <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 NS: <br />Title: <br />Business Address: <br />City: State: Zip: <br />Residential Address: <br />City: State: Zip: <br />Name N2: <br />Title: <br />Business Address: <br />City State: Zip: <br />Residential Address: <br />City: State: Zip: <br />2 <br />