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Get Mold Individual Duplicate License/registration Application - Texas ...

Tion Application DO NOT WRITE IN THIS BOX FOR DEPARTMENT USE ONLY Rcvd Date: Init. Post Mark Date: PLACE Rvw Date: FY: Expiration Date: Init Print Date: Init Mail Date: Init PHOTO Init HERE Aprv Date: Amt Rcvd: $ Init. INSTRUCTIONS: Complete the following and submit with a $20 fee and a 1 X 1 Photo to the address provided above Enter your current license/registration number: Expiration Date: Applicant Name: (Last, First, M.I.) ( Social Security # (mandatory under Family Co.

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