Free 47972.pdf - Indiana

LETTER OF INTENT COSMETOLOGY SCHOOL LICENSE
State Form 47972 (8-96)

State Board of Cosmetology Examiners Indiana Professional Licensing Agency 302 West Washington Street, Room E-034 Indianapolis, Indiana 46204-2246 Telephone: (317) 232-2980

NEW SCHOOL, NEW OWNERSHIP-OTHER THAN CORPORATION, CHANGE OF LOCATION, AND / OR SALE OF SCHOOL This will serve notice to the Board of Cosmetology Examiners of intent to: open a new cosmetology school purchase an existing cosmetology school relocate an existing cosmetology school sell a cosmetology school
Name of cosmetology school

Current address (number and street, city, state, ZIP code)

Telephone number

Approximate date

Cosmetology School license number (if applicable)

Relocation address (if applicable) (number and street, city, state ZIP code)

Name of proposed buyer (if applicable)

Signature(s) of cosmetology school owner(s) or corporate officers:

Date signed (month, day, year)

NOTE: 820 IAC 2-1-3 (a) requires that the applicant submit a letter of intent thirty (30) days PRIOR to submitting an application. Further, 820 IAC 2-1-3 (c) requires that within sixty (60) days of the filing of the notice of intent the applicant must file an application and pay the required fee or the notice of intention shall become null and void. FOR OFFICE USE ONLY
Date Notice of Intent filed: Date application approved:

Date of licensure:

License number:

Board inspectors: