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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 /> <br /> <br />LICENSE APPLICATION FOR – VEHICLE REMOVAL SERVICE <br />MUNICIPAL CODE SECTION – 4-20.5 <br /> <br />III. PERSONAL DATA (Continued) <br />F. Social Security Number: <br />G. Gender: <br />H. Date of birth: <br />I. Race: <br /> <br />IV. ADDRESSES FOR EACH PROPERTY WHERE VEHICLES TOWED BY YOUR COMPANY WILL BE STORED. <br />A. <br />B. <br />C. <br />D. <br />E. <br /> <br />V. INCLUDE WITH APPLICATION: <br />• Detailed schedule of fees. <br />• Current certificate of liability insurance with the City of South Bend listed as the certificate <br />holder. <br />• List of all private properties from which you remove unauthorized vehicles, including names <br />and addresses of property owners. <br /> <br />VI. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION <br /> <br />VII. AFFIRMATION <br /> <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 Vehicle Removal license found in the City of South Bend Municipal Code, <br />Section 4-20.5. <br /> <br /> <br /> <br /> <br />Signature Date