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Get OH Independent Contractor License Application 2011

The Ohio State Board of Cosmetology 1929 Gateway Circle Grove City Ohio 43123 Phone 614 466-3834 Fax 614 644-6880 www. cos. ohio. gov INDEPENDENT CONTRACTOR LICENSE APPLICATION FEE 75. 00 Please make check or money order payable to Treasurer State of Ohio Cash is not acceptable and will be returned Please type or print and use only blue or black ink. Cos. ohio. gov INDEPENDENT CONTRACTOR LICENSE APPLICATION FEE 75. 00 Please make check or money order payable to Treasurer State of Ohio Cash is not acceptable and will be returned Please type or print and use only blue or black ink. Processing of this application may take thirty 30 days. Incomplete applications will be returned. You are required to hold an active current manager s license in order to receive an Independent Contractor s license. The Ohio State Board of Cosmetology 1929 Gateway Circle Grove City Ohio 43123 Phone 614 466-3834 Fax 614 644-6880 www. Processing of this application may take thirty 30 days. Incomplete applications will be returned* You are required to hold an active current manager s license in order to receive an Independent Contractor s license. Both licenses must be displayed in the salon in which you are working and both licenses must be renewed* Last Name First Name Middle Initial Street Address or PO Box City State Zip Code County Required Date of Birth mm/dd/yyyy Area Code Phone No* E-mail Address Manager License Number Required Social Security This application must be notarized AFFIDAVIT State County I swear or affirm that all information contained in this application and the documents attached are true and accurate to the best of my knowledge and belief* Signature of Applicant must be signed in front of the Notary Subscribed in my presence and sworn to before me this day of Year Notary Public - Commission Expiration Date is Required NOTARY SEAL Revised MDR 12/29/2011. Processing of this application may take thirty 30 days. Incomplete applications will be returned* You are required to hold an active current manager s license in order to receive an Independent Contractor s license. Both licenses must be displayed in the salon in which you are working and both licenses must be renewed* Last Name First Name Middle Initial Street Address or PO Box City State Zip Code County Required Date of Birth mm/dd/yyyy Area Code Phone No* E-mail Address Manager License Number Required Social Security This application must be notarized AFFIDAVIT State County I swear or affirm that all information contained in this application and the documents attached are true and accurate to the best of my knowledge and belief* Signature of Applicant must be signed in front of the Notary Subscribed in my presence and sworn to before me this day of Year Notary Public - Commission Expiration Date is Required NOTARY SEAL Revised MDR 12/29/2011. .

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