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all municipal business license questions,contact: City of South Bend-• Department of Community Investment <br />227 Westlefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 •574.235.5912 • F: 574.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III. 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 />Corporation, (if corporation, proceed to 3). <br />1. Sole Proprietor <br />Name:1F/lES �BELWEI�r!/iL <br />Residential Address: SSA} '&449o90 WQI VE <br />";oil <br />* il 54b Zip:44G14 - <br />2. Partnership (List at least two (2) partners) <br />Name #1: <br />Residential Address: <br />City: <br />Name #2: <br />Residential Address: <br />City: <br />State: <br />State: <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 />Residential Address: <br />City: State <br />Name #2: <br />Business Address: <br />Citv: <br />Residential Address: <br />City: <br />State: <br />State: <br />E <br />Zip: <br />Zip: <br />Zip: <br />Zip: <br />2 <br />