Laserfiche WebLink
For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />215 S. Dr. Martin Luther King Jr. Blvd. • Suite 500 <br />South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br /> <br />3 <br /> <br /> <br /> <br />LICENSE APPLICATION FOR - MASSAGE THERAPIST <br />MUNICIPAL CODE SECTION - 4-35 <br />III. BUSINESS DATA <br /> <br />A. Do you intend to be employed with a Massage Establishment: Yes No <br />If yes, name and address of establishment: <br /> <br /> <br />B. Have you ever had a Massage Therapist license, or similar license, suspended or revoked by <br />any governing municipality within three (3) years prior to the date of thisapplication: <br />YES NO <br /> <br />1. If yes, what was the reason? <br /> <br /> <br />2. If yes, what was the business occupation following thesuspension/revocation: <br /> <br /> <br />IV. INCLUDE WITH APPLICATION: <br />• Copy of driver’s license or government issued identification. <br />• Copy of Indiana Professional License approved by the State Board of Massage Therapy. <br />• A diploma or certificate of graduation from a recognized school of massage. <br />• Three (3) passport photos taken within 6 months of application. <br />• St. Joseph County Massage Therapist Permit <br />V. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION <br /> <br />VI. AFFIRMATION <br /> <br />I, hereby, certify and affirm that all the information I have given in this application is true and <br />accurate to the best of my knowledge. I further certify that I have in no way attempted to <br />mislead the City in this application by omitting facts known to me. I agree to cooperate with <br />the City in the investigation of this application. I have read and understand the regulations of <br />the Massage Establishment and/or Therapist license found in the City of South Bend Municipal <br />Code, Section 4-35. <br /> <br /> <br />Signature Date