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Get 1890 Park Marina Drive, Suite 200, Redding, CA 96001

NOTE UNDER SECTION 4 REGARDING LIVESCAN SUBMISSION) RENEWAL APPLICATIONS ARE DUE 30 DAYS PRIOR TO YOUR EXPIRATION DATE!! PRINT CLEARLY USING CAPITAL LETTERS! Only legible completed applications will accepted. All sections of this form must be completed. Incomplete or illegible applications will be returned and will delay your certification. SECTION 1 GENERAL INFORMATION MUST BE COMPLETED BY ALL APPLICANTS 1. LAST NAME, FIRST NAME, MIDDLE INITIAL 6. SOCIAL SECURITY NUMBER: 2. MAILING A.

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