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- MI LARA BPL Social Security Number Affidavit For Licensure 2019
Get MI LARA BPL Social Security Number Affidavit For Licensure 2019-2024
Ion: Legal Name (First, Middle, Last) Telephone Number i License Type Date of Birth (MM/DD/YYYY) 10-Digit MI Permanent ID/License Number, if applicable Email Address Pursuant to MCL 338.3434a of the Regulated Occupation Support Enforcement Act, 1996 PA 236, and MCL 333.16177 of the Michigan Public Health Code, 1978 PA 368, an individual applying for licensure is required to provide his or her social security number at the time of application. You must provide your social security number.
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