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<br />Jun,1S, 2002 10:45AM <br />, <br /> <br />No 6611 p, 2/S <br /> <br />~ <br /> <br /> <br />[] ESCORT SERVICES, MASSAGE PARLORS, RAP PARLORS, SAUNA <br />PARLORS, AND SERVICES <br /> <br />[] MASSAGE PARLOR AS ACCESSORY USE TO BARBER SHOP!HAIR OR <br />BEAUTY SALON (SBCTION 19-199) <br /> <br />[] PERSONAL SERVICE UCENSE <br />(Sections A. B, C, E, F, U IJlllTked by an "') <br /> <br />.. <br /> <br />A. Name of Applicant: <br /> <br />Applicant is a: <br /> <br />[ J Natural Person [ ] Corporation [ ] 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 />docume:lt. <br /> <br />1. True Name <br /> <br />Last <br /> <br />First <br /> <br />Middle <br /> <br />(Malden) <br /> <br />2. Place and Date of Birth <br /> <br />Place <br /> <br />Date <br /> <br />3. Resident Address <br /> <br />Resident Phone <br /> <br />Daytime Phone <br /> <br />4. <br /> <br />Is applicant a United Slates citizen? <br /> <br />[ lYes <br /> <br />[ ] No <br /> <br />5. Iuly nlllllil(s) applicant has ever used or been known by other than true names: <br /> <br />a. <br /> <br />last <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 />