Get Ca 17a-12 2020

This guide provides clear and comprehensive instructions on how to complete the CA 17A-12 form online for a change of permit application with the California State Board of Pharmacy. By following this guide, you can navigate the form efficiently and ensure all necessary information is submitted correctly.

Follow the steps to complete the CA 17A-12 form online:

1. Click the ‘Get Form’ button to access the CA 17A-12 online form and open it in your preferred editor.
2. Complete the licensee information section, including the name of the licensee, license type, and license number as they appear on the license. Ensure the address, email, and contact information are accurate.
3. Indicate the type of change you are applying for by checking all applicable boxes under Section A and Section B. Be mindful to note the effective date of each change.
4. If adding or removing officer(s), partner(s), member(s), or owner(s), provide their full legal names, titles, and addresses. Indicate whether you are adding, deleting, or changing titles for each individual listed.
5. For changes to the corporate name or tradestyle name, provide the new corporate name and ensure it does not exceed 65 characters including spaces.
6. If applicable, include supporting documentation for the changes you are applying for, as outlined in the attached checklist provided with the form.
7. Review all completed sections of the form to ensure accuracy. Double-check for any missing information or errors.
8. Sign and date the form in the designated area. Note that original signatures are required; electronic signatures may not be accepted.
9. Submit the completed form, along with any required fees and supporting documents, according to the submission guidelines provided.

Ensure to complete your CA 17A-12 form online to make the application process smooth and efficient.