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For all municipal business license questions, contact: City of Sauth Bend -Department of community Investment <br />227 West Jefferson Blvd o Sulte 1400 S -South Bend, Indiana 46601 e 574.235.5912 e F:574.235.9021 <br />LICENSE APPLICATION FOR -- OPEN-AIR BUSINESS <br />MUNICIPAL CODE SECTION 4-38 <br />II. BUSINESS DATA (Continued) <br />M. Types of goods to be sold or received: _ _ _., oe <br />N. Scales will be used in business transactions: Yes <br />No —5 <br />If yes, please attach certificate from the Sealer of Weights and Measures. <br />Ili. PERSONAL DATA <br />A. Applicant's Legal Name: <br />E) o <br />ki <br />B. Residential Address: `-fi Lt / e/-? P <br />c� <br />City: `75 State: fm f Zip: <br />C. Residential Telephone Number: 19 <br />D. Cellphone Number: f r n <br />E. Position with business: <br />F. Date of birth: u r -z-(` -72, <br />G. Honorably discharged veteran: Yes No <br />If yes, please attach a copy of your DD214 papers. <br />IV. INCLUDE $S.00 PROCESSING FEE WITH APPLICATION <br />V. INCLUDE SITE PLAN DRAWING OF PROPERTY SHOWING BUILDINGS, PARKING SPACES, AND <br />PROPOSED OPEN-AIR BUSINESS LOCATION. INCLUDE NORTH ARROW. <br />VI. INCLUDE WRITTEN STATEMENT OF PERMISSION FROM PRIVATE PROPERTY OWNER/LESSEE. <br />VII, AFFIRMATION <br />1, hereby, certify and affirm that all of 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 have read and understand <br />the regulations of the Open -Air Business license found in the City of South Bend Municipal <br />Code, S tion 4-38. <br />30/( <br />Slanature Date <br />2 <br />