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ENFMEDAFFState of Michigan 30th Judicial Circuit Ingham County Friend of the CourtAFFIDAVIT OF LICENSED MEDICAL PROFESSIONAL Case No. Judge: Defendant (Name, address & phone)Plaintiff (Name, address
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Begin by reading the instructions provided with the affidavit of licensed form.
02
Fill out the personal information section, including your full name, address, and contact details.
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Provide the information about your license, such as its type, number, and date of issuance.
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Include any relevant details about your licensing authority and expiration date.
05
If required, provide details about any disciplinary actions or suspension related to your license.
06
Sign and date the affidavit at the bottom to certify the accuracy of the information provided.
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Make copies of the completed affidavit for your records.
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Submit the original affidavit to the appropriate recipient or authority as specified.

Who needs affidavit of licensed?

01
Anyone who holds a professional or vocational license may need an affidavit of licensed at some point. This document is often required during employment applications, professional registrations, or when seeking licensure in another jurisdiction. Additionally, individuals who have faced disciplinary actions or suspensions related to their license may also need to submit an affidavit to provide an account of their licensing history.
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An affidavit of licensed is a legal document where a licensed individual attests to their qualifications.
Licensed professionals or individuals who hold a license in a specific field are required to file affidavit of licensed.
To fill out an affidavit of licensed, the individual must provide their personal information, license details, and authenticate the document with a signature.
The purpose of affidavit of licensed is to verify that the licensed individual is qualified and authorized to engage in their profession or field.
The information reported on affidavit of licensed typically includes the individual's name, license number, expiration date, and any relevant qualifications or certifications.
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