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For all municipal business license questions, contact: City of Soutb Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S •SouM Bend, Indiana 46601 • 94.235.5912 • F: S94.335.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III. OWNERSHIP <br />A. Type of owpership (check one): <br />0/ 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 Proprietorl,,�,� �� <br />c,n <br />Name: ( T 1 ��y �nn 11 _CA 4 <br />Resid ntial Add\r—ess' )) \ � m I <br />City: ��' l State' <br />+ ' <br />Zip' 4&JO <br />2. Partnership (List at least two (2) partners) <br />Name#1: <br />Residential Address:. <br />City: State: <br />Zip: <br />Na me #2: <br />Residential Address: <br />City: State: <br />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: <br />Zip: <br />Residential Address: <br />City: State: <br />Zip: <br />Name f12: <br />Title: <br />Business Address: <br />City: State: <br />Zip: <br />Residential Address: <br />City: State: <br />Zip: <br />2 <br />