Form 38924 - Application For Cosmetology Salon License
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1
2APPLICATION FOR COSMETOLOGY SALON LICENSE
Indiana Professional Licensing Agency
302 W. Washington St., Rm. E034
State Form 38924 (R4 / 7-99)
Indianapolis, IN 46204-2700
Approved by State Board of Accounts 1992
Telephone: (317) 232-2980
Your Social Security number is requested
by this agency in accordance with IC 4-1-
8-1. It is not mandatory that it be given.
Social Security number or Federal ID number
Social Security number are available to
the Indiana Department of Revenue.
LICENSE FEE: $40.00
APPLICANT INFORMATION
Name of salon applicant (owner)
Name of salon (not more than 29 characters including spaces)
Address of applicant (owner)
Address of salon
City, state, ZIP code
City, state, ZIP code
Telephone number of salon
Telephone number of owner (residence)
County of salon
(
)
(
)
Name of supervising licensed cosmetologist (six (6) months active experience under IC 25-8-9 prior to application)
License number of supervising cosmetologist
If salon is located on rural route,
Location of salon (check one)
Name of road (if applicable)
give nearest highway number
Business
Residential
For directions from main highway, please indicate the N/S road and E/W road "hundred" numbers in the appropriate
Name of nearest town
spaces below.
North
South
East
West
Give specific directions to salon (exact location with respect to a residence or surrounding building)
Approximate opening date
Normal salon hours
Check days open
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Is this salon connected in any way with residential living quarters?
If Yes, is the salon separated from the residence by a substantial floor to ceiling
partition with a separate entry?
Yes
No
Yes
No
If Yes, explain the nature of the separation
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