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2. City Clerk's Office
   (712) 328-4616
4. Business Information
6. Business name
8. Business address
9. Phone
11. Owner's name
13. Owner's address
14. Phone
16. Place of birth
17. Date of birth
19. Type of business
    -- Select One --Sole proprietorshipPartnershipCorporation
21. Please attach a list of partners and/or corporation officers, state / date of incorporation.
23. Describe the business to be conducted at this location
25. Legal description
27. What type of zoning is at this location?
29. Attach a notarized statement as required by the city's Municipal Code - Section 3.15.070(c)7. Attach a copy of the lease or warranty deed.
31. Manager Information
33. Manager's name
34. Phone
36. Manager's address
38. Place of birth
39. Date of birth
41. Attach proof the owner and/or manager is at least 18 years of age.
45. Applicant signature
46. Date
48. Please return payment of $250 by the renewal date of June 30th to:
    City Clerk
    209 Pearl St.
    Council Bluffs, IA 51503
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50. 1. Receive an email copy of this form.
51. Email address

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