The DH 4147 form is an essential document issued by the State of Florida Department of Health, playing a crucial role for individuals aiming to practice tattooing within the state. As an application for a Tattoo Artist License, it embodies a comprehensive framework that ensures the artist meets the required standards for safety and health protocols. Applicants are guided not to leave any section blank, with instructions to mark "NA" for items that do not apply, ensuring a fully completed submission. The form is structured to accommodate both initial licensing and renewal requests, directing applicants to submit it to the county health department responsible for the tattooing program in their residing area. Moreover, the form outlines necessary attachments such as the license fee, a government-issued photo ID for new applicants, and a certificate from an approved blood-borne pathogens and communicable diseases course, underscoring the seriousness with which Florida addresses public health in the tattoo industry. It also requires applicants to provide information about the establishment(s) where they plan to work, further aligning with the state's commitment to impeccably maintained sanitary conditions in tattoo facilities. By agreeing to the terms on the form, applicants commit to adhering to Florida's health and safety statutes and regulations, underlining the legal and ethical responsibilities of becoming a licensed tattoo artist in the state.
Question | Answer |
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Form Name | Form Dh 4147 |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | E-mail, Licensee, fl application tattoo form, revocation |
DH use only: Check No. |
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Receipt No. |
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Facility Permit No. |
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Date Issued |
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Amended Application Only |
Date Received |
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
Authority 381.00775, Florida Statutes
Application for Tattoo Artist License
Instructions: Do not leave any item blank. Enter “NA” for
Fee of $60.00 (submit every year).
Reactivation fee of $25.00 for renewal of license after date of expiration.
A copy of a
A copy of the certificate of training proving completion of a department approved course on
Type of License: ____ Initial ____ Renewal
Name of Applicant: ______________________________________________________________________________
Physical Address of Applicant: ______________________________________________________________________
StreetCityStateZip Code
Mailing Address if Different: ________________________________________________________________________
P.O. Box or StreetCityStateZip Code
Phone Number: _(____)__________________
Provide the following information for each tattoo establishment or temporary tattoo establishment where the applicant will perform tattooing or intends to perform tattooing:
1. |
___________________________________________________________________________________________ |
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Name of Licensed Establishment |
Department of Health License Number |
2. |
___________________________________________________________________________________________ |
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Name of Licensed Establishment |
Department of Health License Number |
3. |
___________________________________________________________________________________________ |
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Name of Licensed Establishment |
Department of Health License Number |
The undersigned Applicant hereby agrees to practice tattooing in compliance with ss.
Chapter
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Name of Applicant (print or type) |
Date |
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Signature of Applicant |
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DH 4147, 8/12 |