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For all municipal business license questions, corl Cry of South Bend • Department of Community Investment <br />227Wertlefferson Blvd • Suite SCmS •So dh Bend, Indiana 46601 • 574.2355912 • 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 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: X, I F1 seslteel // <br />Residential Address: %�ii ��SALPtY <br />city: _A1 1Sf1Ruk&4�t State: At% Zip: ii�6-`/,5' <br />2. Partnership (List at least two (2) partners) <br />Name #1: <br />Residential Address: <br />City: State: Zip: <br />Name rig: <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 />