APPLICATION TO OPERATE A TATTOO ANDOR BODY PIERCING ESTABLISHMENT

 RIDING ESTABLISHMENTS ACTS 19641970 APPLICATION FOR LICENCE TO
  APPLICATION FORM AND PERSONAL INFORMATION SHEET IF
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FRONT TO THE WORDPRESS APPLICATION THIS FILE
12 FILLING OUT DESCRIPTION OF THE APPLICATION
2013 EDUCATION AND OUTREACH GRANTS APPLICATION FORM

Tattoo and Body Piercing Operation – Inspection Checklist








Application to Operate a Tattoo and/or Body Piercing Establishment

Approval Valid May 1, 2010 – April 30, 2011


INSTRUCTIONS:


  1. Complete the applicable sections. Make any corrections if necessary.

  2. Sign and date the application.

  3. Make a check or money order payable to: Sidney-Shelby County Health Department

  4. Return check of $325.00 and signed application by: April 30, 2010
    to: Sidney-Shelby County Health Department

202 W. Poplar Street, Sidney, Ohio 45365


TYPE OF OPERATION:


Tattooing Body Piercing Tattooing & Body Piercing


BUSINESS INFORMATION:


Name of Tattoo and/or Body Piercing Business: Tax ID#:

Address:

Street

City State Zip Code

Phone Number: ( )


OPERATOR INFORMATION:


Name of Operator: SS#:

Address:

Street

City State Zip Code

Daytime Office Phone Number: ( )

Home Phone Number: ( )

Days of Operation: Hours of Operation:


I HEREBY CERTIFY THAT I AM THE OPERATOR, OR THE AUTHORIZED REPRESENTATIVE OF THE ABOVE OPERATION AND INTEND TO COMPLY WITH ALL REQUIREMENTS ESTABLISHED BY SECTION 3730 OF THE OHIO REVISED CODE AND SECTION 3701 OF THE OHIO ADMINISTRATIVE CODE.


Signed: Date:


APPLICATION TO OPERATE A TATTOO ANDOR BODY PIERCING ESTABLISHMENT


FOR OFFICE USE ONLY:


Approval No.: Issued on:


2018 INTERNATIONAL SUMMER SCHOOL COURSE TEACHING APPLICATION FORM
20XX WRITTEN QUESTIONS ON APPLICATION GUIDELINES AS WE
23 DATE FEBRUARY 23RD 2009 SUBJECT APPLICATION


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