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Jan 11 2017 16:29:30 Via Fax —> Vonage Page 006 of 007 <br />For all n01iclP01 business license questions, eontnct City of South tend + Department O Cornmunity Investment <br />227 West Jefferson tivd - Suite 1400 S •south fiend, Indiana 46601. 574.2.35.5912 • F: 574..235, )021 <br />LICENSE APPLICATION FOR —TRANSIENT MERCHANT <br />MUNICIPAL CODE SECTION - 4-60 <br />H. 13LJSINESS DATA (Continued) <br />Q. Contact person to be responsible for customer complaints and available at least sixty (EO) <br />days following last date of business: <br />Contact's Legal Name; Gregory G. Fountain ,__ <br />Residential Address; „_, , _,,,�, 10740 Three Mile Rvad ­ w_­, _.__.._— <br />City: East LeL ..._ State:._.....__. MI,- Zip: , ,_490�l <br />Telephone Number: ___269;979.8888 .m <br />ill. PERSONAL DATA (Applicant) <br />A. Applicant's Legal Narne; Great y G Fountain _„_ <br />B. Residential Address: 22_Castlereif,h Court _._...-___ ....... <br />City: _ Battle Creetc-._.._- State: MI..-- _ Zip: __,49014 <br />C. Residential Telephone Number: __-_ 734,276,8776 _..._.. <br />D. Cellphone Number: _ _..� same m..- <br />E. Position with business: Vice.president _..� <br />F. Social Security Number; p Mjca_II Iand I will -provide <br />G. Cruder: <br />H. Date of birth: __ 12,(U68 _. <br />I. Race:—.... Cducasa0._ .,. _- .... <br />IV. PERSONAL DATA (Owner', if differs) <br />A. Owner's 4egal Name: _,,,,,_.,_,Same as above <br />B. Residential Address:. <br />City: ..__.._.n — — — _ State: <br />C, Residential' Telephone Number:,, <br />D, Celephone Number: _ <br />E. position with business: _. „ <br />F. Social Security Number: ,_,, ,,­,_­— <br />G, Gender: <br />11, Date of birth:, , <br />I. Race: <br />V. PERSONAL DATA (Additional Owner, it applicable) <br />Zip: <br />A. Owner's Legal Name: Jwiie A. <br />B. Residential Address: 1,0740 Three Mile Road ..._ -. <br />r <br />