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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 />2 <br />LICENSE APPLICATION FOR – RESTAURANT <br />MUNICIPAL CODE SECTION – 4-45 (SEE ALSO 4-46) <br />IV.PERSONAL DATA <br />A.Applicants Legal Name <br />B.Residential Address <br />City State Zip <br />C.Residential Telephone Number <br />D.Cellphone Number <br />E.E-Mail Address <br />F.Position with Business <br />V. OWNERSHIP <br />A. Owners Legal Name <br />B. Residential Address <br />City State Zip <br />C. Residential Telephone Number <br />D. Cellphone Number <br />E. E-Mail Address <br />VI.INCLUDE $5.00 PROCESSING FEE WITH APPLICATION <br />VII.INCLUDE A COPY OF THE ST. JOSEPH COUNTY HEALTH PERMIT <br />VIII.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 regulations of the Restaurant license found in the City of South Bend Municipal Code, <br />Sections 4-45 and 4-46. <br />Signature Date