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• ® 4.r <br /> Beni'record-Permanent Cosmetics and Tattooing Informed Consnt <br /> Last Name First ate <br /> Address <br /> street Apt.s C , ZIP <br /> Date of Birth Location on Body Name of Practitioner <br /> COPY OR DESCRIPTIONOF PERMANENT COSMETICS OR T OO <br /> I accept this design or procedure. Client Signature <br /> ID ID <br /> Permanent Cosmetics and Tattooing P 7 of <br />