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Any change in my address. Signature of Applicant Date Name of Applicant Print 899 North Capitol Street NE Washington DC 20002 877 672-2174 dc.bon dc.gov www. ATTESTATION By signing this Affidavit I acknowledge my understanding agreement with the following 1. 05 b a Social Security number is required to be placed on the application for licensure or certification. In accordance with 466 a 13 of the Social Security Act if you do not have a Social Security number at the time of application you...
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