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REGION FINGERPRINT FEE INSPECTOR NAME/ID NUMBER OTHER FEE TOTAL FEE A Public Service Agency ORIGINAL APPLICATION FOR OCCUPATIONAL LICENSE (PART A) CC SUSPENSE RECEIPT NUMBER SECTION A FIRM INFORMATION Check one box. FOR DEALERS ONLY Check one box in each section. Type of Dealer Autobroker Endorsement Dealer - Complete information on right side. Dismantler Lessor-Retailer Transporter Distributor Manufacturer Remanufacturer SECTION B MAIN OFFICE Retail New Retail Used.

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