Laserfiche WebLink
2 <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 />II. PERSONAL DATA (Continued) <br />J.Date of birth: <br />K.Gender: <br />L.Social Security Number: <br />M.Race: <br />N.Please list all criminal convictions (if any), excluding traffic violations: <br />Nature of Conviction City State Date <br />(Attach additional sheets if necessary) <br />O.Nature of intended work and services to be provided: <br />P.Employment History <br />Please list all previous employment where services related to this field were rendered: <br />Company 1: <br />Dates of Employment: <br />Address: <br />City, State, ZIP: <br />Supervisor: <br />Telephone Number: <br />Company 2: <br />Dates of Employment: <br />Address: <br />City, State, ZIP: <br />Supervisor: <br />Telephone Number: