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For all mumdpal business Ilcen6e questions, contact: city of Soup Bend • Department of Community bNeannem <br />227 WesUef erson BIW • Sulte 3440 5 •Sou h Bend, Were 46601 • 574.2355912 • F: 524.235.5@I <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />III. OWNERSHIP <br />A. Type of owners p(checkone): <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 Proprieto�II^I� -} <br />Name: In4lIAL IfL"YYIYfi�1t� <br />Resider,el=I enn. <br />City: <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 />