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Fw all munidFal buaine license qua nl, wntl Cardswm Bend •Oepmnen[dCwnmuNrylnveskmmt <br />2D Wert leearsen 8IM•Sune1000 S eSnuM Bend, Indiana 4601• 524135.59111 F: s24]a5 2 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />Ill. OWNERSHIP <br />A Type of ownership (check one): <br />uc 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: Berton Enterprises LLO <br />Residential Address: <br />Chr South Bend State: IN Zip: <br />2. Partnership (List at least two (2) partners) <br />Name q1: <br />Residential Address: <br />City: State: Zip: <br />Name M2: <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 N3: <br />Title: <br />BusbessAddress: <br />City: —State;—ZIP; <br />Residential Address: <br />City. State: Ip: <br />Name#2: <br />Title: <br />BusinessAddress: <br />City State: zip: <br />Residential Address: <br />City: —State:—rip: <br />2 <br />