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Get Applicant's Declaration For Special Permit - Dental Board Of California

Usiness & Professions Code 1640 Initial Permit Renewal of Permit Name THIS IS TO CERTIFY that I have read the provisions of Business & Professions Code Article 2.5, Chapter 4, Division 2, 1640, 1641, 1642; that I understand and acknowledge that when my fulltime employment is terminated at (name of dental school) , or when I am employed less than full time by said dental school, Special Permit will be automatically revokes. In accordance with the provisions of 1642(a), I will voluntarily surrend.

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