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For all mur ldpal business license quesdans, mmxa: My of South Rend • DeW rtment of rnmmunny Imertment <br />227Westlelierson Blvd • Suite 14005 •south Bend, Indlana 46601 • 57k235.5912 • F:574.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III.OWNERSHIP <br />A. Type of ownership (check one): <br />Sole Proprietorship (If sole proprietorship, proceed to 1). <br />Partnership (If partnership, proceed to 2). <br />Corporation (If corporation, proceed to 3). <br />1. Sole Proprietor <br />Name: 1 I,[F <br />Residential Address: 16$ W AN MHA TU) <br />City: State: Zip: <br />2. Partnership (List at least two (2) partners) <br />Name #1: <br />Residential Address: <br />City: State: Zip: <br />Name#Z: <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#1: <br />Title: <br />Business Address: <br />City: State: Zip: <br />Residential Address: <br />City: State: Zip: <br />Name #2: <br />Title: <br />Business Address: <br />City: —State:—Zip:— <br />Residential Address: <br />City: State: Zip: <br />2 <br />