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For all munid"I business license questions, contact: City of South Bend • Departmentof Communos Investment <br />227 West lefhrson Blvd, Suite 1Cm 5 asouth Bend, Indiana 401 r 574.235.5912 a F: 574.235.021 <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 <br />Name: <br />Residential Address: <br />City: State: Zip: <br />2. Partnership (List at least two (2) partners) <br />Name#1: )(1640Ht H2 <br />Residential Address: <br />LEE — <br />City ANSION-State Zip: <br />Name#2: gaNOIA Tofi <br />Residential Address: <br />City: State:=Zio:]SEES <br />3. Corporation <br />Legal name ofcorporation: <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 />