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rmME mwidpal bmirea limns quedbns, cmRacc<ByofS Rem! •WWNnantMCommunM74 era <br />M7W lelfdmn BW- Suae DUX) 5-S B0� llldana a6601• 57413559] -F. 570. WLl <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III.OWNERSHIP (Continued) <br />3. Corporation (Cominued) <br />Name83: <br />Business Address: <br />Residemul Address: <br />City: State: ZIP: <br />V7A94 ]0C19 YA0 <br />A. Applicant's Legal Na Deborah A. Barton <br />B. Residential Address: <br />citv„ South BendState: IN Zip: <br />C. Residential Telephone Number. <br />D. Residential Fax Number. WA <br />E. Cellphone Number. 574-28&2956 <br />F.E-Mail Address: dabartonlOG6@91scglobal.nat <br />e 15.41...... ith1....G.me. Founder/Owner <br />H. Please list all criminal convictions (if any), excluding traffrcvtolations: <br />Nature of Conviction City State Date <br />N/A <br />(Attach additional sheets If necessary) <br />I. Please list all addresses for three (3) years prior to application date: <br />Street Address City State Dales <br />lived at same address over 25 years <br />(Attach addition <br />�ry) <br />J. Date of birth: <br />IC Gender: <br />L. Social Secur Number: <br />M. Race: <br />3 <br />