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Get 2012 License Renewal/ce Reporting Form - State Ar

Kansas.gov/fdemb Renewal of your license(s) is due and payable by DECEMBER 31, 2011. $50.00 PER QUARTER/PER LICENSE DELINQUENT FEE WILL BE ASSESSED JANUARY 1, 2012. $30.00 FUNERAL DIRECTORS # RENEWAL FEES: PLEASE PRINT Board ID# $30.00 EMBALMERS # NAME DATE OF BIRTH SSN MAILING ADDRESS City Street State Zip E-mail Address AFFIDAVIT FOR CONTINUING EDUCATION DATE LOCATION COURSE TITLE Over HRS APPROVAL# Have you ever.

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