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3 <br /> <br /> <br /> <br /> <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 /> <br /> <br /> <br />LICENSE APPLICATION FOR – FOOD VENDING MACHINE <br />SOUTH BEND MUNICIPAL CODE SECTION – 10-4 <br />IV. OWNERSHIP <br />A. Type of Ownership (CHECK ONE) <br /> Sole Proprietor (if sole proprietor, skip to V) <br /> Partnership (if partnership, skip to 1) <br /> Corporation (if corporation, skip to 1) <br />1. Give Information for at Least Two (2) Partners <br /> <br />Name <br />Business Address <br />Residence Address <br />Business Telephone Number <br />Residential Telephone Number <br /> <br />Name <br />Business Address <br />Residence Address <br />Business Telephone Number <br />Residential Telephone Number <br /> <br /> <br /> <br /> <br />V. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION <br /> <br />VI. 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 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 Food Vending Machine license found in the City of South Bend Municipal <br />Code, Section 10-7. <br /> <br /> <br /> <br /> <br />Signature Date