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Mobile Food Establishment Application

Department of Health · St. Joseph County, Indiana

Editable official PDF

Edit the agency’s original form, save your draft, attach documents, and review your completed PDF before signing or ordering delivery.

Print and mail service is available for your prepared packet. Review the destination and the agency’s acceptance requirements before ordering. Government payment is separate from document and postage charges.

Applicant fields are mapped to the source PDF. Agency-only fields are reserved.

Official form and instructionsPay the agency directly
Your application steps6 steps · Department of HealthView steps
  1. 1Prepare your answersComplete here

    Edit and save your answers on the official PDF.

    Official source
  2. 2Add supporting documentsComplete here

    Attach the supporting records listed by the agency. Check that every page is legible and complete.

  3. 3Review and signPrepare here, finish outside

    Complete each applicable applicant signature after reviewing the full declarations. Required notary, professional and witness signatures remain separate.

  4. 4Choose paymentPrepare here, finish outside

    Current schedule: $100/unit for prepackaged items or $200/unit for dispensing/food preparation. The older application prints $200/unit. Confirm category and additional application fees. Government fees are separate from the optional prepared PDF and postage. Review the exact amount and recipient before authorizing a check.

    Pay the agency directly
  5. 5Submit or order deliveryPrepare here, finish outside

    Complete the official application and supporting documents. The county online application redirects to the Food Services Payment Form. Confirm applicable total fees and the current receiving floor before sending a mailed packet.

    Official submission instructions
  6. 6Keep your receiptComplete here

    Save your agency confirmation and payment receipt. Track any mailing from My applications. Delivery does not mean the agency approved your application.

Official requirements and sources

Complete your application

Required fields are marked *. Fields follow the agency’s published form. Save your work before leaving this page.

Fill in the official form

Select a highlighted blank and type directly. Use Field list for larger controls and any answers that need a continuation page.

Page 1 of 1 · 29 editable blanks
Revised 01/06/2025 St. Joseph County Department of Health Application for Mobile Food Establishment MFT (Truck) MFE (Trailer) (Other) circle one Name Application Date: Address: City: State: Zip: Contact Person: Phone: ( Business Name: E-mail address: Mobile Food Establishment Information Mobile Truck / Trailer Make: Model: Color: License Plate #: State: Address Where Mobile Unit Will Be Stored: Commissary Name of Commissary: Address: City: State: Zip: Commissary Permit Number: Print Name: Date: Signature: Date: Please see fee schedule at bottom of the application. Fees are not accepted after 4:00 p.m. Our office shall accept Cash, Business Checks, money orders, cashier’s checks, and Visa/Master Card. For Office Use Only! Date Paid: Opening Date: Additional Information Total Amount Paid: $ Permit received on: Transaction #: Department Employee: Permit #: Mobile Food Establishment $200.00 per unit

Select any highlighted blank to type. A larger copy of the selected question appears here.

Review every page before signing. Professional, agency and notary signature areas stay reserved.Original blank form