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For all municiW l business license questions, wntart: City of South Bend - Department of Community Investment <br />227 West Jefferson &vd - Suite 14005-South Bend, Indiana 46601. 574235.5912 - IF 574.235.9021 <br />LICENSE APPLICATION FOR- MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III. OWNERSHIP (Continued) <br />3. Corporation (Continued) <br />Narl <br />Business Address: <br />Residential Address: <br />IV. PERSONAL DATA <br />A. Applicant's Legal Name: Jing Wang <br />B. Residential Address: 11455 McKinley Hwy. <br />city. Osceola State;IN 7;p: 46561 <br />C. Residential Telephone Number: 312-874-0115 <br />D. Residential Fax Number: <br />E. Cellphone Number: 312-874-0115 <br />F. E-mail Address: Jingwang0329@gmaii.com <br />G. Position with business: Owner <br />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 prior to application date: <br />Street Address City State Dates <br />4242 Irish hills dr. Southbend IN 6-2021/ 10/2022 <br />3 <br />