Laserfiche WebLink
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 -TRANSIENT MERCHANT <br />MUNICIPAL CODE SECTION - 4-60 <br />V. PERSONAL DATA (Additional Owner, if applicable) <br />A. Owner's Legal Name: <br />B. Residential Address: <br />City: State: <br />C. Residential Telephone Number: <br />D. Cellphone Number: <br />E. Position with business: <br />F. Social Security Number: <br />G. Gender: <br />H. Date of birth: <br />I. Race: <br />VI. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION <br />WE <br />VII. INCLUDE NAMES, ADDRESSES, AND TELEPHONE NUMBERS OF ALL GROUP EVENT PARTICIPANTS. <br />VIII. INCLUDE A CURRENT CERTIFICATE OF LIABILITY INSURANCE WITH THE CITY OF SOUTH BEND LISTED <br />AS THE CERTIFICATE HOLDER. <br />IX. 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 understand that the <br />completed application must be filed no later than thirty days before the planned event is to <br />begin. I have read and understand the regulations of the Transient Merchant license found in <br />the City of South Bend Municipal Code, Section 4-60. <br />Si tur Date <br />