Application for Mobile Food Vehicle Permit

Applicant Name:

Business or Food Truck Name:

Type of entity: Corporation Partnership S-Corporation LLC Sole Proprietorship

Street address of business:

City/State/Zip of business:

Telephone No.: Fax No.:

Date of submission: Email address:

Description of event for which permit is sought:

Name or general nature of event:

(Examples: “That Day in May”; graduation party; wedding; block party; etc.)

Name of event sponsor/host:

(Must be an Oakwood resident/property owner)

Street address for event:

Date of event: Hours/duration of event:

Estimated number of participants:

Event type: Single (1 day or less) Multi-day (1-3 consecutive days) Regularly-recurring (weekly or monthly)

By signing this form, I/we acknowledge and agree to the following:

1. This form is required by law and is being submitted to obtain a Mobile Food Vehicle permit;
2. The undersigned is duly authorized to sign this document on behalf of the Applicant;
3. If a permit is granted pursuant to this application, the Applicant shall indemnify and hold the City and its officers and employees harmless for any claims for damage to property or injury to persons which may be occasioned by any activity carried out under terms of the permit; and
4. I/we understand that knowingly making a false statement on this permit application form is a violation of Ohio Revised Code Sec. 2921.13(A), which is a first degree misdemeanor punishable by a fine of up to $1,000 and/or up to 6 months in jail.

Applicant signature:

Applicant Signature

Printed name AND title, if any