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For all municipal business license quesbors, mntam City of5outh Bend• cepartmem of community lmmtment <br />227 Wertleaerson BlW - SOW 1400 S -South Bend, Indiana 46601 •574.235.5912 • F: 94]35.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III. OWNERSHI/Checkone): <br />A. Type of ownershi <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. Sale Proprietor <br />Name: tl <br />Resi <br />City: <br />2. Partnership (List at least two (2) partners) <br />Name 41: <br />Residential Address: <br />City: State. Zip: <br />Name H2: <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 Hl: <br />Title: <br />Business Address: <br />City: State: Zip: <br />Residential Address: <br />City: State: Zip: <br />Nameh2: <br />Title: <br />Business Address: <br />Chy' State: Zip: <br />Residential Address: <br />City: State: Zip: <br />2 <br />