Pettis County Health Center | 911 E 16th St. Sedalia, MO 65301 · Businesses and Tattoo Shops 2. It...
Transcript of Pettis County Health Center | 911 E 16th St. Sedalia, MO 65301 · Businesses and Tattoo Shops 2. It...
1.Establishment Information
Date of Application [ ] Existing Establishment [ ] New Establishment
Name of Establishment:
Address:
City: State: Zip Code:
Telephone: Cell: E-mail:
Days of Operation Hours
2. Owner Information
Owner Name:
Owner Address:
City: State: Zip Code:
1. Telephone
Cell
2. Telephone
Cell E-mail
3. Person in Charge
Name:
Address:
City:
State: Zip Code
1. Telephone: Cell E-mail
2. Telephone: Cell E-mail
Return to Pettis County Health Center, 911 East 16th, Sedalia Missouri 65301 or E-mail: [email protected] Complete this application and sign below; acknowledging that you have received, read, understand and will adhere to the Safety Guidelines for Reopening Cosmetology Type Businesses and Tattoo Shops Signature _____________________________________ Date ____________________ Print Name _____________________________________