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4 <br />For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br /> <br /> <br />LICENSE APPLICATION FOR – TATTOO & BODY PIERCING ESTABLISHMENT <br />MUNICIPAL CODE SECTION – 13-125 – 13-152 <br /> <br />I. Please list all addresses for three (3) years prior to application date: <br />Street Address City State Dates <br /> <br /> <br /> <br />(Attach additional sheets if necessary) <br />J. Date of birth: <br />K. Gender: <br />L. Social Security Number: <br />M. Race: <br />N. List any other names or aliases by which you have been known: <br /> <br /> <br /> <br />O. Employment History <br />Please list all previous employment where services related to this field were rendered: <br /> <br />Company 1: <br />Dates of Employment: <br />Address: <br />City, State, ZIP: <br />Supervisor: <br />Telephone Number: <br /> <br />Company 2: <br />Dates of Employment: <br />Address: <br />City, State, ZIP: <br />Supervisor: <br />Telephone Number: