Tattoo Parlor / Body
Piercing License Application
Morgan County Health
Department
180 S.
(765)342-6621
Please Print or
Type
1. Name of establishment
_________________________________
___________________________________________________
2. Business address &
phone #
___________________________
___________________________________________________
3. Owner’s name, address,
and phone # _____________________
___________________________________________________
4. Manager’s name, address,
and phone # ___________________
___________________________________________________
5. Biohazard waste disposal
- Company name
and phone #
___________________________________________________
6. Names, addresses, and
phone #’s of
Artists
(1)
________________________________________________
(2)
________________________________________________
(3)
________________________________________________
(4)
________________________________________________
(5)
________________________________________________
(6)
________________________________________________
7. In case of
emergency, contact (owner,
manager, etc.)
___________________________________________________
8. Fee for License/Permit is
one hundred ($100.00)
dollars.
For Office Use Only
Date issued: ________ Establishment # ________
Amount paid: ________
Comments: