State Form 47266 - Affidavit Completion Of Two Hundred Fifty Hours Of Barber Instruction

ADVERTISEMENT

STATE BOARD OF BARBER EXAMINERS
AFFIDAVIT COMPLETION OF TWO HUNDRED FIFTY HOURS
PROFESSIONAL LICENSING AGENCY
OF BARBER INSTRUCTION
402 West Washington Street, Room W072
Indianapolis, Indiana 46204
State Form 47266 (R2 / 6-08)
Telephone: (317) 234-3031
Reset Form
Pursuant to IC 25-7-1-5 (4) (b) of the Indiana Barber License Law, this is to certify that
________________________________________________________________ satisfactorily completed an additional two
(name of student)
hundred fifty hours of instruction in the theory and practice of Barbering at ______________________________________
(name of school)
___________________________________________________ School license number __________________________
(address of school)
Date of enrollment _________________________________ Date of completion ________________________________
(month, day, year)
(month, day, year)
_________________________________________________________________
(signature of school official)
I hereby certify and declare that the above stated certification of training to be a correct and accurate record of the student
enrolled at the school of barbering named below, and meets the requirements of the Indiana State Board of Barber Examiners.
I understand that providing fraudulent information may be grounds for disciplinary action against the license of the school.
(signature of student)
(signature of school official)
(name of barber school)
(printed name of school official)
STATE OF INDIANA
SS
COUNTY OF ________________
SEAL
Subscribed and sworn to before me this ____________ day of ________________________________ , __________ .
Signature of notary
Printed name of notary
Notary's county of residence
My commission expires (month, day, year)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go