APPLICATION FOR TRANSIENT BODY ART ESTABLISHMENT

APPLICATION FOR TRANSIENT BODY ART ESTABLISHMENT
Fee: $134
All applications must be returned at least two (2) weeks before the event or the permit fee will be doubled. You must fill in all information on this form.
ESTABLISHMENT NAME*
ESTABLISHMENT LICENSE #
ESTABLISHMENT ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
NAME OF CONTACT*

First NameLast Name
CONTACT PHONE*
Please enter a valid phone number.
CONTACT EMAIL*
example@example.com

LICENSED TATTOOISTS/PIERCERS

NAME OF EVENT*
DATE(S) OF EVENT*
DURATION OF EVENT (TIMES)
Information requested on this application must be provided to obtain an establishment license. Personal information you provide may be used for purposes other than that which it was collected (s. 15.04(1)(m), Wis. Stats.). Operating without a license is a violation of Wisconsin Law. If you have been operating without a license, you will be required to pay a surcharge in addition to the license fee. Licenses are not transferable between persons or locations. Licenses expire annually on June 30. The license fee is not prorated for partial license years. The Public Health Division may inspect premises at any reasonable time. Missing information may delay the issuance of your license. The undersigned hereby certifies that this is a true, complete and accurate application.
Signature*

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Print Name*
Date*

MonthDayYear
Date
Should be Empty:

Fee: $134