Public Parking Facility - Beacon Health Systems

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I For all municipal business license questions, contact: City of South Bend - Department of Community Investment 227 West Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 I LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION -4-39 I IV. OWNERSHIP (Continued) A. Type of ownership (continued): j 3. Corporation (continued) Resident Agent: / ff_ f Name: ! .iT7i �All�iiN'`eic3 r ��;; Title: `j.I,Y� � ct I 4c%'rv-m f,4) ��0Se Ee-� j I r "'e _ Business Address: i City: State: Zip: Officers: � Name #1: Title:aeC;Cf LCi� Business Address: i City: State: Zip: Residential Address: City: State: I Zip: Name #2-. i Title: Business Address: City: State: Zip: i Residential Address: City: State: Zip: Name #3: Title: Business Address: I City: State: Zip: Residential Address: City: State: zip: E E i 3