REQUEST FOR DUPLICATE LICENSE

Bureau of Professional Licensing PO Box 30670 Lansing, MI 48909

Telephone: (517) 241-9288 bpl

BPLHelp@

Name on License

Reason for replacement:

Lost

Stolen

Telephone number

REQUEST FOR DUPLICATE LICENSE

Authority: 1979 PA 152

Permanent ID #

Destroyed

E-mail address

_______________________________________________________________

Signature

__________________________

Date

FEE PAYMENT INFORMATION - CHECK ALL THAT APPLY ($10.00 PER REQUEST)

Accountancy - Individual Accountancy - Firm Appraiser, Real Estate Appraisal Management Companies Architect Collection Practices - Individual Collection Practices - Firm Hearing Aid Dealer/Salesperson/Trainee Landscape Architect Personnel Agency - Type A Personnel Agency - Type B Personnel Agency Agent Professional Engineer Professional Surveyor Real Estate - Salesperson Real Estate - Associate Broker Real Estate - Branch Office Real Estate - Individual Broker Real Estate - Broker Company

1101-90 1102-90 1201-90 1202-90 1301-90 2401-90

2402-90 3501-90 3901-90 6101-90 6105-90 6106-90 6201-90 4001-90 6501-90 6502-90

6503-90 6504-90 6505-90

Duplicate license requests for the Cosmetology and Barber Professions please visit miplus

Make your check or money order in U.S. Currency payable to: STATE OF MICHIGAN

FEES ARE AUTHORIZED BY THE STATE LICENSE FEE ACT, 1979 PA 15, AND ARE NOT REFUNDABLE

FOR OFFICE USE ONLY

BPL/ReqDup (Rev. 10/19)

The Department of Licensing and Regulatory Affairs will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, marital status, disability, or political beliefs. If you need assistance with reading, writing, hearing, etc., under the Americans with Disabilities Act, you may make your needs known to this agency.

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