Form Cos013 - Cosmetology Mobile Salon License Application Page 3
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6LIST ALL OWNERS WITH 25% OR MORE OWNERSHIP OF THIS BUSINESS. ATTACH ADDITIONAL PAGES IF NEEDED.
11. Owner Information:
Owner Name or Corporation Name: ____________________________________________________
______%
Ownership
Owner Social Security Number or Federal Tax ID Number:____________________________________
(See instruction sheet for disclosure information)
Owner Date of Birth: _______ - _______ - _______
Month
Day
Year
Cosmetology License Number of Owner:
__________________________________
(if applicable)
Owner or Corporation Mailing Address:
_______________________________________________________________________________________________
Number, Street Name, Suite Number/Apartment Number
____________________________________________________________ Phone Number: (______) _____________
City
State
Zip Code
Area Code
Phone Number
Email Address: _______________________________________________ FAX Number: (______) _____________
(Ex: ) See instruction sheet for disclosure information
Area Code
Phone Number
12. Additional Owners’ Information:
Owner Name: ______________________________ ________________________ __________
______%
Last
First
Middle Initial
Ownership
Owner Social Security Number:
______ ______ ______
_____ _____
______ ______ ______ ______
(See instruction sheet for disclosure information)
Owner Date of Birth: _______ - _______ - _______
Month
Day
Year
Cosmetology License Number of Owner:
__________________________________
(if applicable)
Owner Mailing Address:
_______________________________________________________________________________________________
Number, Street Name, Suite Number/Apartment Number
____________________________________________________________ Phone Number: (______) _____________
City
State
Zip Code
Area Code
Phone Number
Email Address: _______________________________________________ FAX Number: (______) _____________
(Ex: ) See instruction sheet for disclosure information
Area Code
Phone Number
13. Required for a salon license:
Checking the box certifies that I will not open for business until I have met all requirements for opening a salon
and have received the salon license.
14.
STATEMENT OF APPLICANT
I certify that I will comply with all applicable provisions of the Texas Occupational Code, Chapters 51, 1602, and 1603; 16 Texas Ad-
ministrative Code, Chapter 60; and the Cosmetology Administrative Rules, 16 Texas Administrative Code, Chapter 83. I also certify
that I will not open for business until I have met all requirements for opening a salon and have received the salon license. I understand
that providing false information on this application may result in revocation of the license I am requesting and the imposition of admin-
istrative penalties.
_________________
___________________________________________________________________________
Date Signed
Owner or Corporate Officer Signature
_________________
___________________________________________________________________________
Date Signed
Owner or Corporate Officer Signature
TDLR Form COS013 rev February 2017
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