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For all municipal business license question, contac : City of South Bend • Department of communhy In"inent <br />222 West Jefferson BIW • Suite 14 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574R35.91121 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />Ill. OWNERSHIP <br />A. Type of ownership( eckone): <br />Sole Proprietorship (If sole proprietorship, proceed to 1):. <br />j, Partnership (if partnership, proceed to 2). <br />Corporation (if corporation, proceed to 3). <br />1. Sole Proprieto <br />Name:G(��1aLl I I"IUSSG4S L�.tSCU'It(0..� (11 �5 <br />Resid T�id�\al Address: IoVL <br />City: Citi11 P State MJ Zip: � 6b 1-1 <br />2. Partnership (List at least two (2) partners) <br />Name#1: <br />Residential Address: <br />City: <br />Name #2: <br />Residential Address: <br />City: State: Zip: <br />3. Corporation -C' q( �1 1 n' <br />Legal name of corporation _&Lgmi rarfl FFyYtl{1�+--l�, <br />Date and state of incorporation: <br />List officers and directors who own 15%or more of stock: <br />Name #1: <br />Business Address: <br />City: State: Zip: <br />Name#2: <br />City: State: Zip: <br />Residential Address: <br />