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APPLICATION FOR <br /> • [ ] ESCORT SERVICES, MASSAGE PARLORS, RAP PARLORS, SAUNA <br /> PARLORS, AND SERVICES <br /> [ ] MASSAGE PARLOR AS ACCESSORY USE TO BARBER SHOP/HAIR OR <br /> BEAUTY SALON (SECTION I9-I99) <br /> r ] PERSONAL SERVICE LICENSE <br /> (Sections A, B, C, E, F, as marked by an *) <br /> * A. Name of Applicant: � 13d / <br /> Applicant is a: [?CJ Natural Person [ ] Corporation [ I Partnership <br /> [ ] Other Form of Organization <br /> * B. Complete this section if applicant is a natural person or as instructed elsewhere in this <br /> document. <br /> ^ <br /> I. True Name I c t ' �( i,� 1Y141"\ <br /> Last First j Middle (Maiden) <br /> • 2. Place and Date of Birth hit( r' ^sic `S — //`t <br /> Plac Date <br /> 3. Resident Address 2(:) ! C i�r'%- . '�% r- <br /> Resident Phone v L L- s <br /> Daytime Phone % _-6 - ?5 <br /> 4. Is applicant a United States citizen? VI Yes [ ] No <br /> 5. Any name(s) applicant has ever used or been known by other than true names: <br /> a. <br /> Last First Middle (Maiden) <br /> b. <br /> Last First Middle (Maiden) <br /> c. <br /> Last First Middle (Maiden) <br /> • <br /> _d. <br /> Last First Middle (Maiden) <br />