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Get Tx Dshs Ef23-10618 2017

money order made payable to: Texas Department of State Health Services, Food & Drug Licensing, PO Box 12008, Austin, Texas 78711 For assistance in completing this application call (512) 834-6727 TATTOO 2505 BUDGET: ZZ105 FUND: 088 LICENSE # PLEASE NOTE: ADDITIONAL DOCUMENTATION ON PAGE 2 MUST BE SUBMITTED WITH THIS APPLICATION Name Business is Conducted Under (DBA): ______________________________________ Physical Address to be Licensed: City, County, State, Zip Code: Telephone # at address: .

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