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For all municipal business lit ensp questlrns, avrtat t City of South no nd - flelmornpnt of Cornrniin l ty Invastmant <br />.27 West leftrtsrn Blvd - Suite 1400 S -South Bend, Indiana 46601 - 5/4 J 1, 5911 - F ;14 I IS 9WI <br />LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY <br />MUNICIPAL CODE SECTION - 4-39 <br />Ill. PERSONAL DATA Q <br />A. Applicant's Legal Name: <br />B. Residential Address:2'S�D <br />City: C Ir a State: 6R, Zip: gg1lT 1 <br />C. Residential Telephone Number: ZU` 9 5-%-- � 2 <br />D. Residential Fax Number: <br />E. Celephone Number: 2j6 — gs7_ g« 2 <br />F. Position with Business: i <br />IV. OWNERSHIP <br />A. Type of ownership (check one): <br />Sole Proprietorship (if sole proprietorship, proceed to 1). <br />Partnership (If partnership, proceed to 2). <br />L/ Corporation (If corporation, proceed to 3). <br />1. Sole Proprietor <br />Name: <br />Residential Address: <br />City: State <br />Telephone Number: <br />2. Partnership (List at least two (2) partners) <br />Name #1: <br />Residential Address: <br />City: State: <br />Telephone Number: <br />Name #2: <br />Residential Address: <br />12 <br />City: State: Zip: <br />Telephone Number: <br />3. Corporation <br />Legal name of corporation: rrN <br />Date and state of incorporation: — 4?hTa <br />2 <br />