Transcription of REQUEST FOR DUPLICATE LICENSE - michigan.gov
1 Bureau of Professional Li censing PO B ox 30670 Lansing, MI 48909 Telephone: ( 517) 241-9288 REQUEST FOR DUPLICATE LICENSE Authority: 1979 PA 152 Name on LICENSE Permanent ID # Reason for replacement: Lost Stolen Destroyed Telephone number E-mail address _____ _____ Signature Date FEE PAYMENT INFORMATION - CHECK ALL THAT APPLY ($ PER REQUEST ) Accountancy - Individual Accountancy - Firm Appraiser, Real Estate Appraisal Management Companies Architect Collection Practices - Individual Collection Practices - Firm Heari ng Ai d Dealer/Salesperson/Trainee Landscape Architect Personnel Agency - Type A Personnel Agency - Type B Personnel Agency AgentProfessional Engineer Professional Surveyor Real Estate - Salesperson Real Estate - Associate Broker Real Estate - Branch Office Real Estate - Individual Broker Real Estate - Broker Company1101-90 1102-90 1201-90 1202-90 1301-90 2401-90 2402-90 3501-90 3901-90 6101-90 6105-90 6106-90 6201-90 4001-90 6501-90 6502-90 6503-90 6504-90 6505-90 DUPLICATE LICENSE requests for the Cosmetology and Barber Professions please visit your check or money order in Currency payable
2 To: STATE OF MICHIGANFEES ARE AUTHORIZED BY THE STATE LICENSE FEE ACT, 1979 PA 15, AND ARE NOT REFUNDABLE FOR OFFICE USE ONLY BPL/ReqDup (Rev. 10/19) The Department of Li censi ng and Regulatory Affairs will not discriminate against any individual or grou p because of race, sex, religion, age, national origin, color, marital status, disability, or political beliefs. If yo u nee d assistance wit h reading, writing, hearing, etc., under the Americans wit h Disabilities Act, yo u may mak e your needs know n to this agency.
