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For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.23S.9021 <br />LICENSE APPLICATION FOR -- OPEN-AIR BUSINESS <br />MUNICIPAL CODE SECTION - 4-38 <br />BUSINESS DATA (Continued) M. Types of goods to be sold or received: V0 Lice- 6 YV1,1(A)S Cl'/j <br />SOCI _% <br />N. Scales will be used in business transactions: Yes No� <br />If yes, please attach certificate from the Sealer of Weights and Measures. <br />111. PERSONAL DATA <br />A. Applicant's Legal Name: f' aye Y\ H.(,l!,_u. <br />B. Residential Address: 6 U % d I i' h oa P` �— <br />City: ' Sou `vv\, r° Stater I' V Zip' 11414C W <br />C. Residential Telephone Number: <br />D. Cellphone Number: 1�_ 7 V U) _�) 0 <br />E. Position with business: <br />F. Date of birth: �tl� J� ` �`� 7on pe <br />1� <br />G. Honorably discharged veteran: Yes <br />If yes, please attach a copy of your DD214 papers. <br />IV. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION <br />No 11� <br />V. INCLUDE SITE PLAN DRAWING OF PROPERTYSHOWING 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 1 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, Section 4-38. <br />) -dqa0)K-_ <br />Signature Date <br />