Fillable LICENSE APPLICATION FOR POOL HALLS MUNICIPAL CODE SECTION (City of South Bend)

Fill Online, Printable, Fillable, Blank LICENSE APPLICATION FOR POOL HALLS MUNICIPAL CODE SECTION (City of South Bend) Form

Use Fill to complete blank online CITY OF SOUTH BEND (IN) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

LICENSE APPLICATION FOR POOL HALLS MUNICIPAL CODE SECTION (City of South Bend)

On average this form takes 14 minutes to complete

The LICENSE APPLICATION FOR POOL HALLS MUNICIPAL CODE SECTION (City of South Bend) form is 3 pages long and contains:

  • 1 signature
  • 0 check-boxes
  • 51 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of South Bend

BROWSE CITY OF SOUTH BEND (IN) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR – POOL HALLS
MUNICIPAL CODE SECTION – 4-36
DEFINITION:
Pool Hall or Billiard Hall: Any establishment which keeps, maintains, or operates for hire on the
premises four (4) or more pool or billiard tables.
GENERAL INSTRUCTIONS:
1. Print legibly and complete all sections to ensure efficient processing.
2. Assemble all required information and materials before filing application.
3. Thoroughly review all applicable Municipal Code Sections listed above.
4. Licenses expire January 31.
5. Add 10% to license fee for renewal after January 31.
6. Include $5.00 license application fee payable to City of South Bend.
7. License fee payable to City of South Bend due at issuance - $100.00.
REQUIRED INFORMATION AND MATERIALS:
1. Facility seating capacity and number of employees.
APPLICATION PROCESS:
1. Submit Application with $5.00 Processing Fee.
2. Police background check of applicant.
3. Inspection by Fire and Building Departments, as required.
4. License issued upon approval and payment of the license fee.
5. See Municipal Code Section 4-16 for denial or revocation.
1
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR – POOL HALLS
MUNICIPAL CODE SECTION – 4-36
I. APPLICATION TYPE Check One: New Renewal
II. BUSINESS DATA
A. Business Name:
B. Business Address:
City: State: Zip:
C. Mailing Address (If different from above):
City: State: Zip:
D. Business Telephone Number:
E. Business Fax Number:
F. E-Mail Address:
G. Maximum Seating Capacity:
H. Number of Employees:
I. Zoning of Business Location:
III. OWNER'S PERSONAL DATA
A. Owner's Legal Name:
B. Residential Address:
City: State: Zip:
C. Residential Telephone Number:
D. Cellphone Number:
E. Social Security Number: F. Gender:
G. Date of Birth: H. Race:
For Office Use Only
Application Filed Building Dept. Approval
Application Fee Paid Fire Dept. Approval
Sent to Dept. License Fee Paid
Police Dept. Approval License Number
Not Approved
Reason
2
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR – POOL HALLS
MUNICIPAL CODE SECTION – 4-36
IV. OPERATOR'S PERSONAL DATA (If same as owner, skip to Section V)
A. Operator's Legal Name:
B. Residential Address:
City: State: Zip:
C. Residential Telephone Number:
D. Cellphone Number:
E. Social Security Number: F. Gender:
G. Date of Birth: H. Race:
V. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION
VI. AFFIRMATION
I, hereby, certify and affirm that all of the information I have given in this application is true and
accurate to the best of my knowledge. I further certify that I have in no way attempted to
mislead the City in this application by omitting facts known to me. I have read and understand
the regulations of the Pool Halls license found in the City of South Bend Municipal Code, Section
4-36.
Signature Date
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

LICENSE APPLICATION FOR POOL HALLS MUNICIPAL CODE SECTION (City of South Bend)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 16 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document