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Get the free Duplicate Annual Registration Certificate Request and Name Change Form

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Use this form to request a duplicate license or permit issued by the State Board of Dentistry, including name changes. Follow instructions on filling out the form and submitting the required fees. Processing time may take 2-4 weeks.
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How to fill out duplicate annual registration certificate

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How to fill out duplicate annual registration certificate

01
Contact the appropriate department or agency that issued the original annual registration certificate
02
Fill out any necessary forms or provide required information such as identification and proof of ownership
03
Pay any associated fees for the duplicate certificate
04
Wait for processing and receive the duplicate annual registration certificate

Who needs duplicate annual registration certificate?

01
Any individual or organization who has lost or damaged their original annual registration certificate and needs a replacement
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A duplicate annual registration certificate is a replacement certificate issued when the original certificate has been lost, stolen, or damaged.
Any individual or entity who has lost their original annual registration certificate is required to file for a duplicate.
To fill out a duplicate annual registration certificate, you must provide the necessary information and documentation to the issuing authority.
The purpose of a duplicate annual registration certificate is to provide a replacement for the original certificate in cases where it is lost, stolen, or damaged.
The duplicate annual registration certificate must contain all the same information as the original certificate, including registration details and expiration date.
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