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For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601. 574.235.5912 - F: 574.23S.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />Ill. OWNERSHIP (Continued) <br />3. Corporation (Continued) <br />Name #3: <br />title: <br />Business Address: <br />City:__ _ State: <br />Residential Address: <br />City; <br />IV. PERSONAL DATA <br />State: <br />A. Applicant's Legal Name: MeiLi SuNWendell Sheldon <br />B. Residential Address: 14535 Day Road <br />City: Mishwaka State: IN Zip: <br />C. Residential Telephone Number: 302-428-1205 <br />D. Residential Fax Number: <br />E. Cellphone Number: _ <br />F. E-Mail Address: 1726065950@QQ.com <br />G. Position with business: Owner <br />H. Please list all criminal convictions (if any), excluding trafficviolations: <br />Nature of Conviction City State <br />(Attach additional sheets if necessary) <br />1. Please list all addresses for three (3) years prior to application date: <br />Street Address City State <br />14535 Day Road Mishawaka IN <br />(Attach additional sheets if necessary) <br />J. Date of birth: <br />K. Gender: <br />L. Social Security Numbe __ <br />M. Race: <br />3 <br />Zip: <br />46545 <br />Date <br />Dates <br />2018-Present <br />