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SUBSTITUTE RENEWAL FORM APPLICATIONMississippi State Board of CosmetologyPost Office Box 55689Jackson, MS 39296-5689(601) 359-1820In the event you have misplaced your renewal form, please complete the following:PRACTITIONERNameAddressCity/State/ZipPhoneRegistration NumberExpiration DateSALONSalon NameSalon AddressCity/State/ZipPhoneRegistration NumberExpiration Date ................
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