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1 <br />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 /> <br />LICENSE APPLICATION FOR – CHARITABLE SOLICITATION <br />MUNICIPAL CODE SECTION - 4-55 <br /> <br />I. APPLICATION TYPE Check One: New Renewal <br /> <br />II. ORGANIZATION INFORMATION <br />A. Name of Applying Organization: <br />B. Organization Address: <br />City: State: Zip: <br />C. Mailing Address (if differs): <br />City: State: Zip: <br />D. Organization Telephone Number: <br />E. Organization Fax Number: <br />F. Organization E-Mail Address: <br />G. If Organization is a Corporation or Partnership, list names and addresses of all principal <br />officers. If not, skip to Section III. <br />(Attach additional sheets if necessary) <br /> <br />Name #1: <br />Title: <br />Business Address: <br />City: State: Zip: <br />Residential Address: <br />City: State: Zip: <br />Business Telephone Number: <br />Home Telephone Number: <br /> <br /> <br /> <br /> <br />For Office Use Only <br /> <br />Application Filed Police Department <br />Application Fee Paid Controller Approval <br />Sent to Dept. License Fee Paid <br />License Number <br /> <br />Not Approved <br />Reason