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For all municipal business Ilcanse Questions, contact City of South Send • Department of CommunYry Imprtment <br />222 West Jefferson BNtl • Suite 14005 -South Bend, Indiana 4E101 • 574.235.5912 • F. 510.235.9021 <br />LICENSE APPLICATION FOR -MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />Ill. OWNERSHIP (Continued) <br />3. Corporation (Continued) <br />Business <br />Residential Address: <br />IV. PERSONAL DATA <br />A <br />A. Applicant's Legal Na <br />B. Resident. ' AAA.,, <br />Cit, likii <br />C. Residential Telephone Number: <br />D. Residential Fax Number: <br />E. Cellphone Number: <br />F. E-Mail Address: 4 C1:C7'A'1 <br />G. Position with business: Q� 5� <br />H. Please list all criminal convictions (if any), ex, <br />x u ing 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 />