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Get IL I 172 2018-2024

X Department, 111 E. Monroe, Springfield, IL 62756. Last Name: First Name: Name of Business Employer: Driver’s License or State ID Card Number (attach a photocopy): Business Address: Street: Middle Name or Initial: City: Business Telephone Number: State: ZIP Code: Applying for: ■ New Commission Date of Birth: ■ Renewal of Commission Current Expiration Date: _________ Commission Number: ____________ County of Business: Home Phone: Home Address: Street: City: State: ZIP Cod.

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