Laserfiche WebLink
1 <br />For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />215 S. Dr. Martin Luther King Jr. Blvd. • Suite 500 <br />South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br /> <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 /> <br />Not Approved <br />Reason <br /> <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 /> <br /> <br /> <br />H. 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 /> <br />I. Name and address where the applicant intends to perform services: <br />