Application for Replacement Registration Certificate
New York State License Number-Birth Date. Month . Day. YearLast 4 Digits of Social Security Number Daytime Telephone Number. Home or. BusinessArea Code Phone. Contact Email . Home or. Business. Mail this form and $10 fee to: New York State Education Department, Office of the Professions, Registration Unit, 89 Washington Ave, Albany, NY 12234 ... ................
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