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For all municipal business license 9ues0ons,omtxt:City of South Bend• Department a Cammuniry Imeaa ment <br />227 Wertlefferson BIW • Suka 19005 eSoudn Bend, Indiana 466CI • 96135.5912 • F: S74.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />Ill. OWNERSHIP <br />A. Type of ownership (check one): <br />74L Sole Proprietorship (If sole proprietorship, proceed to 1). <br />Partnership (If partnership, proceed to 2). <br />Corporation (If Corporation, proceed to 3). <br />1. Sole Proprietor <br />Name: <br />Residential dd <br />City: 4 d. C,F7 aG State: 1.ft/ Zip: 4—(�k&r <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: Zip: <br />Residential Address: <br />City; State: Zip: <br />2 <br />