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For all municipal business license questions, contact: CM of South Bend • Depanme,tt of Community Investment <br />227 West Jefferson Blvd • Suite 14005 'South Bend, Indiana 46601 •5J4.BS.5912 • F: 524.235 9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4.35 <br />Ill. OWNERSHIP <br />A. Type of ownership (check one): <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. Sole Proprietor, ( II//�� <br />Name: Ff`f.r,(Q.1 L• t.. 42'i see <br />Residential Address: <br />: «� 53� F�.61�{ gAJ46t ��• <br />City: a"�`��l State: (" Zip: L�(nl'�(q <br />2. Partnership (List at least two (2) partners) <br />Name ill <br />Residential Address: <br />Name N2: <br />Residential <br />3. Corporation <br />Legal name of corporation: _ <br />J9 <br />Date and state of incorporation: <br />List officers and directors who own 15%or more of stock: <br />City: State: Zip: <br />Residential Address: <br />Name <br />Residential Address:. <br />