Laserfiche WebLink
For all municipal business license questions, contact: City of South Bend • Department of Common" Investment <br />222 Wert Jefferson Blvd • Suite 14005 •South Bend, Indiana 46601 • 524.235.5912 • F: 574.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III. OWNERSHIP (Continued) <br />3. Corporation (Continued) <br />IV. PERSONAL DATA <br />A -Applicant's Legal Name: <br />B. Residential Address:G <br />C. Residential Telephone Number: <br />D. Residential Fax Number: ^ <br />E. Cellphone Number: 1 <br />F.E-Mail Address: <br />G. Position with business: H. Please list all criminal convictions (if any), excluding trafficviolations: <br />Nature of Conviction City State Date <br />(Attach additional sheets if necessary) <br />I. Please list all addresses for three (3) years priorto application date: <br />Street Address city State Dates <br />. <br />J. Date of b, <br />L. Social <br />M. Race: <br />