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For all municipal busnress Incense questions, coined: City of South fiend • Department of Community Investment <br />327Wertle&rwn Blvd • 5uite 1b0 S -South Bend, Indiana 1601 •574.235.5912 • F:570.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION -4-35 <br />Ill. OWNERSHIP <br />A. Type of ownershiphec ne): <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: <br />Residential Address: I loI— <br />City: Si State: K"^IZfp: V 22 <br />2. Partnership (List at least two (2) partners) <br />Name #1: <br />Residential Address: <br />City: State: Zip: <br />Name#2: <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#1: <br />Title: <br />Business Address: <br />City: State: Zip. <br />Residential Address: <br />City: State: Zip: <br />Name #2: <br />Title: <br />Business Address: <br />City: State: Zip: <br />Residential Address: <br />City: State: Zip: <br />2 <br />