Laserfiche WebLink
For au municipal business license questions, contact: city of South Bend • Department of Comm unity Investment <br />227 West Jefferson Blvd •sulte 1400 s 150uth Bend, Ind lam 0501 •574.235.5912 • F: 574.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III. OWNERSHIP (Continued) <br />3. Corporation (Continued) <br />Name #3: <br />Business Address: <br />Residential Address: <br />IV.PERSOP <br />A. <br />B. <br />C. Residential Telephone Number <br />D. Residential Fax Number:. <br />E. Cellphone Number: <br />F. E-Mail Address:�— <br />G. Position with business: <br />H. Please list all criminal convictions (if any), excluding traffic ofations: <br />Nature of Conviction City State Date <br />(Attach additional sheets if neces%ary) <br />I, Please list all addresses forthree (3) years priorto application date: <br />Dates <br />I , I. It it <br />