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<br />J,n,28, 2002 IO:45AM <br />, <br /> <br />No 6621 P 2/8 <br /> <br />~.to -ro--1-vO~ I . ~Lt\'~vlJ <br />[] ESCORT SERVraS, 1 $A8fll' ORS,.lUU' l'AKLUKS, SAuNA' <br />PARI.ORi, .'\l're .mKYICES <br /> <br /> <br />f] :MASSAGE PARLOR AS ACCESSORY USE TO BARBER SHOPIHAIR OR <br />BEAUTY SALON (SECTION 19-199) <br /> <br />[] PERSONAL SERVICE LICENSE <br />(Sections A, B, C, E, F, as marked by an *) <br /> <br />.. <br /> <br />A. Name of Applicant: <br />Applicant is a: <br /> <br />[ 1 Natural Person [ ] Cmporation [ ] Partnership <br />[ ] Other Form of Organization <br /> <br />.. <br /> <br />B. Complete this section if applicant is a natural person or as instructed elsewhere in this <br />document. <br /> <br />1. True Name <br /> <br />Last <br /> <br />First <br /> <br />Middle <br /> <br />(Maiden) <br /> <br />2. Place and Date of Birtb <br /> <br />Place <br /> <br />Date <br /> <br />3. Resident Address <br /> <br />Resident Fhone <br /> <br />Daytime Phone <br /> <br />4. <br /> <br />Is applicant a United Slate. citizen? <br /> <br />[ lYes <br /> <br />[ ] No <br /> <br />S. MY name(s) applicant has ever used or been known by other than true names: <br /> <br />a. <br /> <br />!.ast <br /> <br />First <br /> <br />Middle <br /> <br />(Maiden) <br /> <br />b. <br /> <br />Last <br /> <br />First <br /> <br />Middle <br /> <br />(Maiden) <br /> <br />c. <br /> <br />Last <br /> <br />First <br /> <br />Middle <br /> <br />(Maiden) <br /> <br />d. <br /> <br />Last <br /> <br />First <br /> <br />Middle <br /> <br />(Maiden) <br />