INSTRUCTIONS SECTION A: LICENSEE INFORMATION - …

BarberCosmo ' ' ' D DD D DDDDDD D D D DODD DDDDDDDD DDDDDDDDDD D D PERSONAL LICENSE RENEWAL Cashiering Use Only: 2020 Entity # Receipt # Amount $ INSTRUCTIONS Mail this form and a check or money order (do not send cash) (fee for each license type renewal below) to the address above payable to the Board of Barbering and Cosmetology (incomplete forms will not be processed). You can also renew your license online at . SECTION A: LICENSEE INFORMATION LICENSE TYPE AND FEE: If postmarked If postmarked on or before after expiration date. expiration date. Barber (1001) $ $ * Cosmetologist (1002) $ $ * Electrologist (1003) $ $ * Esthetician (1004) $ $ * Manicurist (1005) $ $ * *Based on a 2 year NUMBER: Letter(s): Numbers:Last Name (print clearly) First Name Middle Name If your name has changed, attach completed Change of Name form with this renewal*. Last 4 digits of your Social Security Number or Individual Taxpayer Identification Number Date of Birth --Month Day Year If your address has changed, please fill out the INFORMATION below: Previous Street Address City State Zip Code Current Street Address City State Zip Code Telephone Number--E-mail AddressSECTION B: BACKGROUND INFORMATION 1.

Effective July 1, 2012, the State Board of Equalization and the Franchise Tax Board may share taxpayer information with the board. You are obligated to pay your state tax obligation and your license may be suspended if the state tax obligation is not paid. (Revised January 2015) Page 2 …

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