Free 44672.FH11 - Indiana

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NOTICE OF INTENT TO OPEN, BUY, RELOCATE, SELL OR CLOSE A SCHOOL OF BARBERING
State Form 44672 (R3 / 5-08)

STATE BOARD OF BARBER EXAMINERS PROFESSIONAL LICENSING AGENCY 402 West Washington Street, Room W072 Indianapolis, IN 46204 Telephone: (317) 234-3031 www.pla.IN.gov

I (we) hereby serve notice to the State Board of Barber Examiners, of intent to: 1. OPEN A NEW SCHOOL OF BARBERING
Approximate opening date (month,day, year) Name of school of barbering

Location (number and street, city, state, and ZIP code) Telephone number

(
2. BUY AN EXISTING SCHOOL OF BARBERING
Approximate opening date (month,day, year) Name of school of barbering

)

Location (number and street, city, state, and ZIP code) Will location of school change?

Telephone number

(
Yes No

)

If Yes, new location of existing school of barbering? (number and street, city, state, and ZIP code)

3. RELOCATE AN EXISTING SCHOOL OF BARBERING
Approximate opening date (month,day, year) Name of school of barbering

Current location (number and street, city, state, and ZIP code) New location (number and street, city, state, and ZIP code) Telephone number

(
4. SELL AN EXISTING SCHOOL OF BARBERING
Approximate opening date (month,day, year) Name of school of barbering

)

Current location (number and street, city, state, and ZIP code) Name of purchaser Address of purchaser (number and street, city, state, and ZIP code) Telephone number

(
5. CLOSE AN EXISTING SCHOOL OF BARBERING
Approximate closing date (month,day, year) Name of school of barbering

)

Location (number and street, city, state, and ZIP code)

Telephone number

(
Dated this __________ day of _________________________________, ______________.
Signature of owner / partner / corporate officer Printed name of owner / partner / corporate officer

)

Date signed (month, day, year)