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For all municipal business Ikense questions, contact: OW of South Bend • Department of Community Investment <br />22J WeAJcf emmn aFA Suite IqW 5 South Send, Incline 46WI • 574.Z5.5912 • F. 57knS9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III.OWNERSHIP <br />A. Type of ownership (check one): <br />X Sole Proprietorship (If sole proprietorship, proceed to 1). <br />Partnership (If partnership, proceed to 2). <br />Corporation (If rorporation, proceed to 3). <br />1. Sole Proprietor <br />Name: <br />Residen(ntlal'�A� '2 <br />d'ress: <br />City: swtL F]ratd State: L 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: Zip: <br />3. Corporation <br />Legal name of corporation: <br />Date and state of incorporation: <br />List officers and directors who own 1S% or more of stock: <br />Name #1: <br />Title: <br />I Business Address: <br />City: State: Zip: <br />Residential Address: <br />City: State: Zip: <br />Name #2: <br />Title: <br />Business Address: <br />City: State: Lp: <br />Residential Address: <br />City: State: Lp: <br />2 <br />