Laserfiche WebLink
For all municipal business Ilcenu quesdars, contact CM/ of South Bentl • Depatlment of Community Investment <br />W Weatleflerow BIM -Suite 1a005 •So M Bend, Indiana 06601 • 570.235.5912 • F: 574.a95.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />Ill. OWNERSHIP <br />A. Type of ownership eckone): <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: 5fvzA 12� VVS Zile, <br />Residential Address: VD <br />City: State: \a zip: LAV, 6kav <br />2. Partnership (List at least two (2) partners) <br />Name #1: <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 />Namell <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 />