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For all municipal business license questions, mmam Cry of South Bend • Department of community Investment <br />227 WestAsfferson Blvd • suite 1400 S •South Bend, Indiana 46WI • 574,235,5912 • F: 576.23SM21 <br />LICENSE APPLICATION FOR -TRANSIENT MERCHANT <br />MUNICIPAL CODE SECTION -4-60 <br />II. BUSINESS DATA (Continued) <br />Q. Contact person to be responsible for customer complaints and available at least sixty(60) <br />days following last date of business: <br />Contact's Legal Name: Kristen SII(orsld-Conklin <br />Residential Address: <br />city: South Bend State: IN z;p: <br />Telephone Number: <br />III. PERSONAL DATA (Applicant) <br />A. Applicant's Legal Name:Kristen Slkorskl-Conklin <br />B. Residential Address: <br />city: South Bend State:IN zip: <br />C. Residential Telephone Number: NSA <br />D. Cellphone Number: <br />E. Position with business: Fair Board President <br />F. Social Securit Number: - <br />G. Gender: <br />H. Date of birth: <br />I. Race= <br />IV. PERSONAL DATA (Owner, if differs) <br />A. Owner's Legal Name: <br />B. Residential Address: <br />City: State: Zip: <br />C. Residential Telephone Number: <br />D. Cellphone Number: <br />E. Position with business: <br />F. Social Security Number: <br />G. Gender- <br />H. Date of birth: <br />I. Race: <br />2 <br />