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2 <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 />LICENSE APPLICATION FOR – RUBBISH AND GARBAGE REMOVAL <br />MUNICIPAL CODE SECTION - 4-48 <br />IV. VEHICLE INFORMATION <br />A.Name of vehicle owner (if differs from applicant name): <br />B.Residential Address: <br />City: State: Zip: <br />C.Vehicle license number and issuing state: <br />D.Vehicle Identification Number (VIN): <br />E.Vehicle Year, Make, and Model: <br />F.Number of Licenses Applied for: <br />Non-Restricted (Proceed to 1): <br />Restricted (Proceed to 2): <br />1.If Non-Restricted: (Completely Enclosed) <br />Type of Vehicle: <br />Quantity of Material held in Vehicle: <br />2.If Restricted: (Covered with a Tarp) <br />Type of Vehicle: <br />Quantity of Material held in Vehicle: <br />Type of Material to be Transported: <br />Type of Covering to be used: <br />Hours Vehicle will be used to Transport Material: <br />V.INCLUDE $5.00 PROCESSING FEE WITH APPLICATION <br />VI.INCLUDE A LIST OF THE RESIDENTIAL CUSTOMERS TO BE SERVICED ON A REGULAR BASIS <br />VII. 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 Rubbish and Garbage Removal license found in the City of South Bend <br />Municipal Code, Section 4-48. <br />Signature Date