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For all municipal business Ike nse questions, contact: CI[y of South Bend • Department of community Imestment <br />227Wealeffemon BNtl • 5ulte 14005 -South Bend, Indiana 46WI • 574.235.5912 a R 5)42B5.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III. OWNERSHIP <br />A. Type of ownership (check op): <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 C <br />Name: JAI A <br />Residential Address <br />City: State: )IS:q(oo <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 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 />