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3 <br />FFor 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 />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: Zip: <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 />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 />Signature Date