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ZIP Code , 20 , . Signature Notary Public Date Commission Expires Notes: The Texas Nurse Aide Registry will return (without action) incomplete requests and requests without required documents. Tampering with or attempting to falsify a government record as such a nurse aide certificate is a third-degree felony punishable by up to 10 years in prison and a $10,000 fine. Form 5507-NAR Page 2 / 07-2014-E Address: To meet waiver eligibility requirements, Nurse Aide Registry staff.

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