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2 <br />For all municipal business license questions, contact: 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 – MOBILE FOOD VENDOR VEHICLE <br />MUNICIPAL CODE SECTION – 4-45 (SEE ALSO 4-46) <br />III.PERSONAL DATA <br />A.Applicant's Legal Name: <br />B.Residential Address: <br />City: State: Zip: <br />C.Residential Telephone Number: <br />D.Cell Phone Number: <br />E.Position with Business: <br />F.E-Mail Address: <br />IV.GENERAL QUESTIONS <br />A.Will food be sold by weight or measure? <br />Yes No <br />If yes, please attach a certificate from the Department of Weights and Measures. <br />B.What type of license are you applying for? 1-day 30-day 90-day Annual <br />C.If participating in an event, what are the event dates? <br />V.INCLUDE $5.00 PROCESSING FEE WITH APPLICATION <br />VI.INCLUDE A CERTIFICATE OF LIABILITY INSURANCE <br />VII.INCLUDE A COPY OF THE ST. JOSEPH COUNTY FOOD SERVICE PERMIT <br />VIII.INCLUDE A COPY OF THE COMMISSARY FOOD SERVICE PERMIT <br />IX.INCLUDE A LETTER OF PERMISSION FROM THE PROPERTY OWNER IF OPERATING ON PRIVATE <br />PROPERTY <br />X.AFFIRMATION <br />I, 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 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 required regulations for the Mobile Food Vendor License found in the City of South Bend <br />Municipal Code, Sections 4-45 and 4-46. <br />Signature Date