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STATE OF MAINE BOARD OF DENTAL PRACTICELICENSE VERIFICATION REQUEST (Revised 06/2019)REQUESTORS INFORMATION (please print) FULL LEGAL NAMEFIRSTMIDDLE INITIALLASTCOMPANY MAILING ADDRESSCITYSTATEPHONE

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Required Fees 25 is a form used by certain organizations or individuals to report specific fees or payments due to government entities.

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Entities or individuals who are obligated to pay certain fees or who fall under specific regulatory requirements are required to file Required Fees 25.

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To fill out Required Fees 25, gather all necessary information, complete each section accurately, and ensure that all fees are calculated correctly based on the guidelines provided.

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The purpose of Required Fees 25 is to ensure compliance with payment obligations and to provide transparent reporting of fees to the appropriate regulatory body.

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Information to be reported includes the entity's details, the fee amounts, payment dates, and any relevant compliance information.

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