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For all municipal business llceme question; canted: Oty of South Bend • Department of Community Invesnnent <br />222 West Jefferson Blvd • 5uie 1Q05 •South Bend, Indiana E6601 •574.235.5912 • F: 574235.9021 <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 to2). <br />Corporation (If corporation, proceed to3). <br />1. Sole Proprietor <br />Name: L/ w <br />Residential Address: <br />City:2LrI1 4,rt State: 7� Zip: CL(a l <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 />Tile: <br />Business Address: <br />City:: State: zip: <br />Residential Address: <br />City: State: Zip: <br />2 <br />