Transcription of INSTRUCTIONS SECTION A: LICENSEE INFORMATION
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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*.
b . mi . INFORMATION COLLECTION, ACCESS AND DISCLOSURE The Information Practices Act, Sec. 1798.17 Civil Code, requires the following information to be provided when collecting information from individuals. AGENCY NAME . Board of Barbering and Cosmetology . TITLE OF OFFICIAL RESPONSIBLE FOR INFORMATION MAINTENANCE . Executive Officer . ADDRESS
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