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For all muNupal business license questions, coma& City of stuff Bend • BCyartment of Community Investment <br />227 Weztleffersm &vtl • Suite 14005'South Bend, Indiana 466M • 574335.5912 • 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 Pmprietorship(if sale proprietorship, proceed to 1). <br />Partnership (If partnership, proceed to 2). <br />Corporation (If Corporation, proceed to 31. <br />1. Sole Proprietor <br />Name: Jing Wang <br />Residential Address: 914 B Ironwood <br />Oty: South Bend State:ln <br />Zip; 46615 <br />2. Partnership (List at leasttwo (2) partners) <br />Name#1: <br />Residential Address: <br />City State: <br />Zip: <br />Name #2: <br />Residential Address: <br />City: State: <br />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: <br />Zip: <br />Residential Address: <br />City: State: <br />Zip: <br />Name#2: <br />Title: <br />Business Address: <br />CRy: State: <br />Zip: <br />Residential Address: <br />City: State: <br />Zip: <br />2 <br />