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This form is used to request changes to an EMS license, including name changes, address changes, or to request a duplicate license from the Michigan Department of Community Health.
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How to fill out data changeduplicate license request
How to fill out DATA CHANGE/DUPLICATE LICENSE REQUEST
01
Obtain the DATA CHANGE/DUPLICATE LICENSE REQUEST form from the appropriate licensing authority website or office.
02
Fill out all required personal information, including your full name, address, and contact information.
03
Indicate the reason for the request (data change or duplicate license) clearly in the designated section.
04
Provide any necessary documentation that supports your request, such as identification or proof of address changes.
05
Review the completed form to ensure all information is accurate and complete.
06
Submit the form either online or at the designated office, along with any required fees.
07
Keep a copy of the submitted form and any confirmation received for your records.
Who needs DATA CHANGE/DUPLICATE LICENSE REQUEST?
01
Individuals who need to update their personal information on their license due to changes such as marriage, divorce, or relocation.
02
Those who have lost their original license and require a duplicate for legal identification purposes.
03
People whose names have changed and need to reflect this change on their existing license.
04
Individuals whose license has been damaged and needs to be replaced.
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What is DATA CHANGE/DUPLICATE LICENSE REQUEST?
The DATA CHANGE/DUPLICATE LICENSE REQUEST is a formal application submitted to update or correct information on an existing license or to request a duplicate of a lost or damaged license.
Who is required to file DATA CHANGE/DUPLICATE LICENSE REQUEST?
Individuals or entities that need to update their information on an existing license or have lost their license are required to file the DATA CHANGE/DUPLICATE LICENSE REQUEST.
How to fill out DATA CHANGE/DUPLICATE LICENSE REQUEST?
To fill out the DATA CHANGE/DUPLICATE LICENSE REQUEST, complete the provided form by entering the current license information, the specific changes needed, and any required supporting documentation.
What is the purpose of DATA CHANGE/DUPLICATE LICENSE REQUEST?
The purpose of the DATA CHANGE/DUPLICATE LICENSE REQUEST is to ensure that the licensing information is accurate and up-to-date or to obtain a replacement for a lost or damaged license.
What information must be reported on DATA CHANGE/DUPLICATE LICENSE REQUEST?
Information that must be reported includes the current license number, the specific data changes required, personal identification details, and any relevant supporting documents that validate the request.
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