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Mbc.ca.gov STATE OF CALIFORNIA BCIA 8016 orig. 04/2001 rev. 01/2011 DEPARTMENT OF JUSTICE REQUEST FOR LIVE SCAN SERVICE Applicant Submission A0383 ORI Code assigned by DOJ LICENSE CERTIFICATION PERMIT Authorized Applicant Type PHYSICIAN SURGEON Type of License/Certification/Permit OR Working Title Maximum 30 characters - if assigned by DOJ use exact title assigned Contributing Agency Information 05612 Agency Authorized to Receive Criminal Record Information Mail Code five-digit code assigned...
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