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P:: <br /> �� . Board of Cosmetologist Examiners <br /> 2829 University Avenue SE, Suite 710 <br /> * �;� b�A BOARD OF Minneapolis, MN 55414 <br /> OLOGIST EXAMINERS 651-201-2742-612-617-2601(fax) <br /> www.bceboard.state.mn.us- bce.board@state.mn.us <br /> Salon license Application <br /> -MAKE A COPY OF THIS APPLICATION FOR YOUR RECORDS- <br /> THE BCE IS ON A THREE-YEAR LICENSE CYCLE. A LICENSE CANNOT BE ISSUED FOR MORE THAN THREE YEARS. THUS,YOUR INITIAL <br /> LICENSE MAY EXPIRE IN LESS THAN THREE YEARS. <br /> Please complete all of the following questions. Failure to have a complete application will result in a delay of your <br /> safon license as the application will be returned. <br /> A Salon License attaches to a single owner or business structure and is not transferable under any circumstances. <br /> Owning and operating a salon under another person or business license is illegal. <br /> "The data which you furnish on this application will be used by the BCE to assess your qualifications for licensure.Disclosure of this information is voluntary. You are <br /> not legally required to provide this data,however if you fail to do so,the BCE may be unable to process this appliwtion. Disclosure of your Social Securiry number is <br /> required by Minnesota Statutes 270C.72 and your Social Security number may be requested by and released to the Min�esota Commissioner of Revenue. Then BCE <br /> may use your Social Security Number for revenue recapture as authorized by Minnesota Statutes,Chapter 270A.After issuance of a license,all information contained <br /> in this application,except your Social Security Number,will be public information pursuant to Minnesota Statutes,Chapter 13." <br /> Pursuant to Minnesota Statutes 604.113 and 609.535 the BCE is authorf:ed to charge a service charge of 530.00 for any check that is retumed for non-su�cient funds. <br /> License Fee• <br /> • $143.00 License Fee Total (Payable to the BCE,Credit Cards Not Accepted) <br /> ■ $130.00 Application Fee <br /> ■ $13.00 Office of Enterprise Technology License Surcharge Fee�nnN sess�o��w zoo9:cnapter ios,Art.2,Sec.59,Subd.3) <br /> Check Tvae of Salon License <br /> In order to obtain a Cosmeto/ogy Sa/on License,your sa/on must have a floor p/an that includes all Cosme[ology Services including <br /> shampoo bowls and hair service stations. If you do not have a,tloor plan that indudes those services,but p/an to offer manicurist and <br /> esthetician services,please comp/ete both a Manicurist and Esthetician Sa/on Application and submit together. <br /> Cosmetology Salon o Manicurist Salon o Esthetician Salon <br /> Check Tvpe of Business Structure <br /> � Individual Proprietor o Partnership Corporation o Other Business Structure <br /> � <br /> Salon Information <br /> �/zoo9 <br /> Salon Name(DBA—Doing Business As) Salon Legal Name <br /> ���`�� _S'�. c� <br /> Owner Last/Corporation Name Owner First Name <br /> �10 =-� �.2�?��'� <br /> For Office Use Only: <br /> Staff Initials: Check/MO/Receipt Number: Amount Paid: <br /> Application Number: License Number: Date Processed: <br />