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Get Mold Remediation Worker License Application/Renewal - Texas ... - Dshs State Tx

Wal DO NOT WRITE IN THIS BOX FOR DEPARTMENT USE ONLY Rcvd Date: Init. Amt Rcvd: $ PLACE PHOTO HERE Post Mark Date: FY: Expiration Date: Init Rvw Date: Init Print Date: Init Aprv Date: Init. Mail Date: Init PLEASE COMPLETE THE FOLLOWING If renewing: Enter your current license/registration number: Applicant Name: (Last, First, M.I.) Expiration Date: Social Security # (mandatory under Family Code, Chapter 231.302(c)(1)) ( ) Telephone Number (including area code) Date of Birth.

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