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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: 574.235.9021 <br />LICENSE APPLICATION FOR - OPEN-AIR BUSINESS <br />MUNICIPAL CODE SECTION - 4-38 <br />II. BUSINESS DATA (Continued) g <br />M. Types of goods to be sold or distributed: <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 />u j ■»:jYQ Lj fAj N 1]UJ ra <br />A. Applicant's Legal Name: �_-r 4,11C,-A, C ,k,�t.-y-('-e � <br />B. Residential Address: Cv ( b' — <br />City:_ �ULi11� sett <br />C. Residential Telephone Number: 4 <br />D. Cellphone Number: <br />Wvw— <br />E. Position with business: <br />r�� <br />_ s 7'- <br />State:,z/ z Zip:. vlt:� <br />F. Date of birth: !11/i l I ►� 4 Social Security Number :Sj [i <br />G. Honorably discharged veteran: Yes No <br />If yes, please attach a copy of your DD214 papers. <br />IV. INCLUDE $5.00 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 PROPERTYOWNER/LESSEE. <br />VII. AFFIRMATION <br />I, hereby, certify and affirm that all 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, Section 4-38. <br />Signature Date <br />FN <br />