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Get CA 55C-4 2007-2021

below to obtain a replacement license:  Complete this form and attach a check or money order for $25.00 made payable to the “BVNPT.”  Mail the form and check to the Board at the address shown above.  Please allow 3-4 weeks for processing your request. PRINT OR TYPE (DO NOT USE PENCIL) 1. Last Name First Name 2. VN License #: Date of Birth Middle Name Social Security Number (Optional) 3. Address (Street or PO Box Number) 4. City 5. Telephone Numbers State Business ( )_______.

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