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For all municipal buslnesslicensequestion , comam City of South Send • Department of Community Investment <br />227 WestleRetson BIW Suite lY0s-South Bend, Indlaw 46601• 574335.5912• F: 57&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 to3). <br />1. Sole Proprietor <br />Name: 4`II <br />Residential Address: <br />City: �W State: Zip: <br />2. Partnership (List at least two (2) partners) <br />Name #1: <br />Residential Address: <br />City: State: Zio: <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 />CRY State: .Zip: <br />Residential Address: <br />City: State: Zip:_. <br />2 <br />