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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 />LICENSE APPLICATION FOR – VEHICLE REMOVAL SERVICE <br />MUNICIPAL CODE SECTION – 4-20.5 <br />III.PERSONAL DATA (Continued) <br />F.Social Security Number: <br />G.Gender: <br />H.Date of birth: <br />I. Race: <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 />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 />VI.INCLUDE $5.00 PROCESSING FEE WITH APPLICATION <br />VII. 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 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 />Signature Date