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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: 574.235.9021 <br />ReC .7 1 D©A1 $091,05:'_0 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT CAS R <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One: New Renewal e� <br />II. BUSINESS DATA <br />A. Business Name: <br />B. Business Address: S. Lan 11,r 2 r, <br />City: 5�f,, .l �l e �l State: j"V Zip: �/bl,6 /S <br />C. Mailing Address (If different from above): <br />City: State: Zip: <br />D. Business Telephone Number: 57 % <br />E. Business Fax Number: <br />F. E-Mail Address: Jil >.L & L F y--, <br />G. Zoning of Business Location: C& . e h n I <br />H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked <br />by any governing municipality within three (3) years prior to the date of this application: <br />YES NO !l <br />1. If yes, what was the reason: <br />2. If yes, what was the business occupation following the suspension/revocation: <br />I. Describe the nature and scope of the business: /0 SS4,:2e -fh 'e <br />J. Include a list of massage therapist employed at this location: (include a separate sheet if necessary) <br />A* <br />For Office Use Only <br />Application Flied FEB 2 2 7023 Public Safety Approval <br />Application Fee PaidFER 2 2 mn License Fee Paid <br />Sent to Dept. FEB 2 2 License Number [r]!SC. A{ 91,6—O Itp <br />o l i CFO ? 3 ja .3_.,f I (c ,./Z0 n j B� _ 2 3 2 l-deal-�-h -# �--5 o[ <br />Not Approved ^ CITY OF SOUTH BEND, INDIANA <br />RlIA RTI rTF PT iRT T!` Wl1RTCC �� <br />Reason <br />1*aa <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />M„rrav T. Mill— MPmhx <br />I' <br />Joseph R. Molnar, Vice President <br />Jordan V. Gathers, Member <br />Aft—t• ThP . M Hrffnx ('1-1, <br />T7 <br />Date: April 25, 2023 <br />