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For all municipal business Ilcome quetlons, mirtam 00 of south Send • Departmemof CommuNry Investment <br />222 Wertleffl Bled • Suite IWO S ISouM Bend, Indiana 46WI 574.235.5912 • F: 524235.9n21 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III.OWNERSHIP <br />A. Type of ownership (check 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: MxlssG Vb S <br />Residential Address: <br />City: tate: 1W Zip: qL*G( <br />2. Partnership (List at least two (2) partners) <br />Name ttl: <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 stock: <br />Name N1: <br />Title: <br />Business Address: <br />City: State: Zp: <br />Residential Address: <br />City: State: Zip: <br />Name k2: <br />Title: <br />Business Address: <br />City: State: Zip: <br />Residential Address: <br />City State: Zip: <br />2 <br />