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2 <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 /> <br /> <br /> <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 /> <br /> <br /> <br />(Attach additional sheets if necessary) <br /> <br />O. Nature of intended work and services to be provided: <br /> <br /> <br /> <br />P. 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: