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REQUEST FOR LIVE SCAN SERVICE Applicant Submission ORI A0040 Type of Application LICENSE CERT OR PERMIT Code assigned by DOJ Job Title or Type of License Certification or Permit Manufactured Home Dealer SEE BACKSIDE FOR LIST OF APPLICABLE HCD APPLICATION TYPES Agency Address Set Contributing Agency Calif. Dept. O p t ion a l Live Scan Transaction Completed By Date Name of Operator Transmitting Agency ATI No. Amount Collected/Billed NOTE Illegible incomplete or incorrect information may result...
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