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10. Please verify that you do not currently hold or have held an active 3 -way license for this location <br />within the past 12 months. <br />Please submit this form and all attachments to: Riverfront License Review Committee C/O Downtown <br />South Bend, Inc. 217 S. Michigan Street, South Bend, IN 46601. <br />Please attach: <br />1. Your completed Indiana State form entitled "Application for New or Transfer Permit" along <br />with any attachments. <br />2. A signed copy of the eligibility requirements <br />3. A signed copy of the criteria sheet. <br />4. A copy of your business plan (should include financial and ownership strengths) <br />5. A copy of your proposed permanent signage <br />6. A tentative menu <br />Permits are not transferable, not portable within or without the district and any renewal are subject <br />to compliance with the terms of these local rules and any agreement negotiated with the Riverfront <br />License Review Committee. The permits shall not be pledged as collateral or subject to any lien, <br />judgment, property settlement agreement, or third party claim. <br />APPLICANT'S CERTIFICATION <br />The Applicant certifies that all information in this application and all information furnished in support of <br />this application are true and complete to the best of the Applicant's knowledge and belief. I have read <br />and understand the procedures and agree to follow the Riverfront License Review Committee Process. <br />I am submitting documentation as requested. <br />Applicant's Signature: Date: <br />Draft 4/3/12 <br />