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For all munid WI business license questlnm, cones City of South Bend • Department of Community Iroe#men[ <br />227 Wea Jefferson BIM• suite 1YN 5 south Bend, Indiana AoM• 574.Z35.5912• F: 574.235.9023 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION -4-35 <br />Ill. OWNERSHIP <br />A. Type of ownership (check one): <br />X Sale Proprietorship (if sole proprietorship, proceed to 1). <br />Partnership (If partnership, proceed to 2). <br />Corporation (If corporation, proceed to3). <br />1. Sole Proprietor <br />Name:AWll AP)"4 <br />Residential Address: L,R744ye4e46r1u Zi" r,21Z <br />City: Garde//& State: XC Zip: Z/GS-34 <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: Zlp: <br />2 <br />