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For all munlcipal business Ilcense questlons, contact: City Of South Bend • Uepartmentof Community Investment <br />227 West Jefferson Blvd • 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 />XX Sole Proprietorship (If sole proprietorship, proceed to I) - <br />Partnership (If partnership, proceed to 2). <br />Corporation (If corporation, proceed to 3). <br />1. Sole Proprietor <br />Name: MeiLi SunMendell Sheldon <br />Residential Address: 14535 Day Road <br />City: Mishawaka <br />State: IN <br />Zip: 46545 <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: _ <br />3. Corporation <br />State: <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 />Zip: <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: 7.ip: <br />2 <br />