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2 <br />For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />215 S. Dr. Martin Luther King Jr. Blvd. • Suite 500 <br />South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br /> <br /> <br />LICENSE APPLICATION FOR – SCRAP METAL DEALERS/JUNK DEALERS/RECYCLING <br />OPERATIONS <br />CITY OF SOUTH BEND, INDIANA <br />MUNICIPAL CODE SECTION – 4-51 <br />III. PERSONAL DATA <br /> <br />A. Applicant's Legal Name: <br />B. Residential Address: <br />City: State: Zip: <br />C. Residential Telephone Number: <br />D. Cellphone Number: <br />E. Social Security Number: F. Gender: <br />G. Date of Birth: H. Race: <br />I. Position with Business <br /> <br /> <br />IV. INCLUDE, WITH APPLICATION, A SITE PLAN OF THE FACILITY SHOWING PROPERTY LINES, BUILDINGS, <br />PARKING SPACES, LOADING DOCKS, FUEL STORAGE, AND LANDSCAPING. <br />V. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION <br /> <br />VI. INCLUDE A COPY OF THE INDIANA SECRETARY OF STATE CERTIFICATE OF ORGANIZATION <br />CONFIRMING THAT THE BUSINESS IS REGISTERED AND IS DULY QUALIFIED TO DO BUSINESS IN THE <br />STATE OF INDIANA. <br /> <br />VII. LICENSEE MUST COMPLY WITH ALL LOCAL AND STATE REGULATIONS REGARDING SCRAP METAL <br />DEALERS, INCLUDING THOSE REALTED TO RECORD KEEPING, IDENTIFICATION, AND REPORTING. <br /> <br />VIII. AFFIRMATION <br /> <br />I, hereby, certify and affirm that all the information I have given in this application is true and <br />accurate to the best of my knowledge. I further certify and affirm that I have in no way <br />attempted to mislead the City in this application by omitting facts known to me. I have read and <br />understand the regulations of the Scrap Metal Dealer/Junk Dealer/Recycling Operation/Transfer <br />Station license found in the City of South Bend Municipal Code, Section 4-51. <br /> <br /> <br /> <br /> <br />Signature Date