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For all municipal business license que ibons, contact: City of South Bend • 0epar[mentof Community Investment <br />227 Wea eRerson Blvd • Suite 1E00 5 •SouN Bend, IMalaria 46601 a 574.235.5912 a 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 />N Sole Proprietorship (If sole proprietorship, proceed to I) - <br />Partnership (# partnership, proceed to 2). <br />Corporation (If corporation, proceed to3). <br />1. Sole Proprietor <br />Name: PcIJVJ IDMP500 <br />Residential Address: <br />City:.PA La State: T9 Zip: <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'. ]i p: <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: 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 />