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Get Data Changeduplicate License Request Form - Michigan
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How to fill out the Data Change Duplicate License Request Form - Michigan online
Filling out the Data Change Duplicate License Request Form in Michigan online is a straightforward process. This guide will provide you with clear, step-by-step instructions to ensure that you complete the form accurately and effectively.
Follow the steps to complete your form online
- Click ‘Get Form’ button to obtain the form and open it in an editing tool.
- Begin by entering your name as it currently appears on your license. This includes your first, middle (if applicable), and last names.
- Input your 10-digit Michigan Permanent ID or license number. If you have multiple numbers, list additional ones in the provided space below.
- Indicate the specific license or registration change being requested. Selection options include Professional License/Registration, Controlled Substance, Drug Control, Drug Treatment Prescriber, and Specialty License.
- Request a duplicate license by stating the reason for the request: Data Change, Lost, Stolen, or Destroyed. If your license is expiring within 60 days, you do not need to pay for a duplicate.
- Review the fee structure, ensuring you understand that there is a $10 fee for each duplicate license. Payment should be made via check or money order, made payable to the State of Michigan.
- Once completed, ensure all information is accurate, then save your changes. You may download, print, or share the form as needed.
Complete the Data Change Duplicate License Request Form online now to manage your licensing needs efficiently.
Related links form
You may renew your license, apply for a new license, make name and address changes, or reprint your license in our new system www.michigan.gov/miplus beginning 8/25/2020. If you need assistance contact the Bureau of Professional Licensing at BPLHelp@michigan.gov or 517-241-0199.