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[PDF File]Duplicate License/Registration Request
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www.dos.ny.gov and search our index of licensees and registrants for your current license/registration information. Submit a separate form for each duplicate license/registration request. Mail this form with a check or money order
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[PDF File]Data Change and Duplicate License - Michigan
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DUPLICATE LICENSE - $10.00 for EACH license: I request the Department to issue a duplicate license for the following reason: Data Change Lost Stolen Destroyed : If your license will expire in the next 60 days, you do not need to pay for a duplicate license. You …
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[PDF File]REQUEST FOR DUPLICATE LICENSE REQUEST FOR CHANGES TO …
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Harrisburg, PA 17105-2649 2601 North Third Street Harrisburg, PA 17110 . REQUEST FOR DUPLICATE LICENSE REQUEST FOR CHANGES TO AN INDIVIDUAL LICENSE This request form is used to process a change of personal name and/or address on an individual license or to request a duplicate copy of an existing license.
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[PDF File]Request for Duplicate License - Michigan
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REQUEST FOR DUPLICATE LICENSE AUTHORITY: 1979 PA 152 PENALTY:FAILURE TO PROVIDE THE INFORMATION MAY RESULT IN DENIAL OF YOU R REQUEST. Name on License: License Number Reason for Replacement : Destroyed Signature. Date. FEE PAYMENT INFORMATION - CHECK ALL THAT APPLY . Make your check or money order in U.S. Currency payable to: STATE OF MICHIGAN. FEES ARE AUTHORIZED UNDER 2004 PA 403 & 1980 PA ...
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[PDF File]Duplicate License Form - New Jersey Division of Consumer ...
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Duplicate License Form Please complete this affidavit, have it notarized and return it to this office, together with the appropriate fee ($35.00 for RNs/LPNs/APNs and $10.00 for CHHAs).
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[PDF File]COMMONWEALTH OF PENNSYLVANIA STATE BOARD OF …
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STATE BOARD OF NURSING P.O. BOX 2649 HARRISBURG, PA 17105-2649 PHONE: (717) 783-7142 FAX: (717) 783-0822 www.dos.pa ... Select State Board of Nursing •License Type - Select Registered Nurse or Practical Nurse •Survey - Please answer all questions on the survey to obtain the correct application and instructions. PLEASE NOTE: You can apply for a Graduate Temporary Practice …
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Request duplicate nursing license pa