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For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />222 Wert Jefferson Blvd • Suite 14005 -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 eck one): <br />Sole Proprietorship (If sole proprietorship, proceed to 1). <br />Partnership (If partnership, proceed to2). <br />Corporation (If corporation, proceed to 3). <br />1. Sole Proprietor (� <br />Name::'qQ� <br />Residential Address: �rmn`1 <br />C. CZQA\l'(-tom State:Zlp:� <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 st <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 Addr s: <br />City: State: Zip: <br />11esit:107 Address: <br />City: State: Zip: <br />2 <br />