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For all municipal businesslicensequestions, contact: City ofsouth Send• ouparo entof Community Investment <br />227 West Jefferson Blvd • Suite 1400 s •South Bend, Indiana 46601 • 576235.59n • F.524235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />Ill. OWNERSHIP <br />A. Type of ownership (check one): <br />x 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:Jina Wang <br />Residential Address: <br />City;Osceola state :IN zip:46561 <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 />Ti6e: <br />Business Address: <br />City; State: Zip: <br />Residential Address: <br />City: State: Zip: <br />2 <br />