MFV/Tattoo
Instructions for Completing the Standard Application
New York City Health Code, Section 3.19 states: “No person shall make a false, untrue or
misleading statement or forge the signature of another on a certificate, application,
registration, report, or other document required to be prepared pursuant to this Code. No
person shall make a false, untrue or misleading oral statement to the Department as to any
matter investigated by the Department.”
NOTE: Any form with alterations, corrections, whiteout, etc., will not be
accepted.
Complete all sections of the application. If completing it by hand, please use ink and write
in CAPITAL
LETTERS.
1. License or Permit Name
o Enter the name of the permit or license you want to obtain.
2. Section A
o Enter the individual owner’s name, or all partners’ names or corporation name in the
box labeled “Name of Corporation, partnership or individual owner” (the permit will be
issued to the corporation, partnership or person named here)
o Enter the name of the establishment in the space labeled “Trade Name/DBA”
o Provide the address where the establishment will be located. Please include in the
space
labeled “Premises Location” the floor, booth number, or store number where the
establishment is to be located.
o Enter the establishment’s telephone, fax and the email address (if any).
All correspondence sent by email will be sent to this address.
o Provide your date of birth, if applying as an individual
3. Section B
o Enter the date you expect to start operating.
4. Section C
o Enter your New York State Tax Authority ID #. If applying as an individual, also enter
your Social Security Number. If you do not have a Social Security number, you may
use an Individual Tax Identification Number (ITIN)
5. Section D
o Enter the mailing address if it is different from where the establishment is going to
be located. All correspondence sent by mail will be sent to this address.
6. Section E
o Enter the name, home address, zip code, phone number, email address and title of
the owner/all partners in the business/all principal officers in the corporation
7. Section F
o This section is required for Mobile Food Vendor permittees. It is not required for Tattoo
licenses nor Mobile Food Vendor licensees.
8. Signature
o Sign the application.
Note: the person who signs the Application must be named in Section E
.
o Enter the title and telephone number of the person who signed the Application for Permit
o Indicate whether the applicant is 18 years of age or older.
Note: applicants must be older than 18 years of age.