The license statement must contain:
(1) the name under which the business is conducted;
(2) the address of each place of business that is licensed;
(3) the name and residence address of:
(A) the proprietor, if the business is a proprietorship;
(B) all partners, if the business is a partnership; or
(C) all principals, if the business is an association;
(4) the date and place of incorporation, if the business is a corporation;
(5) the names and residence addresses of the individuals in an administrative capacity showing:
(A) the managing proprietor, if the business is a proprietorship;
(B) the managing partner, if the business is a partnership;
(C) the officers and directors, if the business is a corporation; or
(D) the persons in a managerial capacity, if the business is an association; and
(6) the residence address of an individual in charge of each place of business.