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For all municipal business license questions, contact: City of south Bend • Department of Cammunay Investment <br />229 Wertlefferson Blvd • suite 1400s -South Bend, Indiana 066011574.B55912 I F: 57E.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION -4-35 <br />Ill. OWNERSHIP <br />A. Type of owners In (checkone): <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 <br />Name: <br />Residential Add <br />City:C7 r!a State, N Zip: LIlC.k i4 <br />2. Partnership (List at least two (2) partners) <br />Nana HI. <br />Residential Address: <br />City: State: <br />s <br />Name #2: <br />Residential Address: �— <br />.... _ a....... Jin <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 />Tile: ^� <br />Business Address: <br />CRY: <br />Residential Address: <br />City: <br />Name #2: <br />Business Address <br />City: State: Zip: <br />Residential Address: <br />City: State: Zip: <br />2 <br />