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1 <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 />LICENSE APPLICATION FOR – TATTOO & BODY PIERCING ARTIST <br />MUNICIPAL CODE SECTIONS – 13-125 – 13-152 <br />I.APPLICATION TYPE Check One:New Renewal <br />II.PERSONAL DATA <br />A.Applicant's Legal Name: <br />B.Residential Address: <br />City: State: Zip: <br />C.Residential Telephone Number: <br />D.Residential Fax Number: <br />E.Cellphone Number: <br />F.E-Mail Address: <br />G.List any other names or aliases by which you have been known: <br />H.Please list all addresses for three (3) years prior to application date: <br />Street Address City State Dates <br />(Attach additional sheets if necessary) <br />I.Name and address where the applicant intends to perform services: <br />For Office Use Only <br />Application Filed Health Dept. Approval <br />Application Fee Paid Police Dept. Approval <br />Sent to Dept. License Fee Paid <br />License Number <br />Not Approved <br />Reason