Form DBPR BCAIB9 "Application to Reinstate Null and Void Certification" - Florida

What Is Form DBPR BCAIB9?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 10, 2012;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DBPR BCAIB9 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR BCAIB9 "Application to Reinstate Null and Void Certification" - Florida

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State of Florida
Department of Business and Professional Regulation
Building Code Administrators and Inspectors Board
Application to Reinstate Null and Void Certification
Form # DBPR BCAIB 9
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION REQUIREMENTS
ALL Applicants must submit:
Fees:
$125
Make check payable to the Florida Department of Business and Professional Regulation.
Supporting Documentation:
Proof of a minimum of 14 hours of current continuing education credit. Please visit
www.myflorida.com/dbpr/pro/build/index.html
to view information regarding continuing education.
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
S
Tallahassee, FL 32399-0783
DBPR BCAIB Reinstate Null and Void Certification
Eff. date: 07/10/2012
Incorporated by Rule: 61-35.008
1 of 5
State of Florida
Department of Business and Professional Regulation
Building Code Administrators and Inspectors Board
Application to Reinstate Null and Void Certification
Form # DBPR BCAIB 9
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION REQUIREMENTS
ALL Applicants must submit:
Fees:
$125
Make check payable to the Florida Department of Business and Professional Regulation.
Supporting Documentation:
Proof of a minimum of 14 hours of current continuing education credit. Please visit
www.myflorida.com/dbpr/pro/build/index.html
to view information regarding continuing education.
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
S
Tallahassee, FL 32399-0783
DBPR BCAIB Reinstate Null and Void Certification
Eff. date: 07/10/2012
Incorporated by Rule: 61-35.008
2 of 5
State of Florida
Department of Business and Professional Regulation
Building Code Administrators and Inspectors Board
Application to Reinstate Null and Void Certification
Form # DBPR BCAIB 9
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
For additional information see the Instructions at the end of this application.
Section I – Applicant Personal Information
LICENSEE INFORMATION
License Number:
*Social Security Number:
Last Name
First
Middle
Suffix
MAILING ADDRESS
Do you wish to mark your address private, pursuant to
YES
NO
Section 119.071(4), Florida Statutes?
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
CONTACT INFORMATION
Primary Phone Number
Primary E-Mail Address
ADDITIONAL CONTACT INFORMATION (OPTIONAL)
Alternate Phone Number
Fax Number
Alternate E-Mail Address
* The disclosure of your Social Security number is mandatory on all professional and occupational license applications, is solicited
by the authority granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business and Professional Regulation
pursuant to §§ 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and
licensees by a Title IV-D child support agency to assure compliance with child support obligations. It is also required by § 559.79(1),
Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. § 405(c)(2)(C)(i), to be
used by the Department of Business and Professional Regulation to identify licensees for tax administration purposes.
DBPR BCAIB Reinstate Null and Void Certification
Eff. date: 07/10/2012
Incorporated by Rule: 61-35.008
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Section II – Explanation of Illness or Economic Hardship
EXPLANATION
DBPR BCAIB Reinstate Null and Void Certification
Eff. date: 07/10/2012
Incorporated by Rule: 61-35.008
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Section III – Affirmation by Written Declaration
AFFIRMATION BY WRITTEN DECLARATION
I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I
understand that my signature on this written declaration has the same legal effect as an oath or
affirmation. Under penalties of perjury, I declare that I have read the foregoing application and the facts
stated in it are true. I understand that falsification of any material information on this application
may result in criminal penalty or administrative action, including a fine, suspension or revocation
of the license.
Signature:
Date:
Print Name:
DBPR BCAIB Reinstate Null and Void Certification
Eff. date: 07/10/2012
Incorporated by Rule: 61-35.008
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INSTRUCTIONS
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
Application Instructions (by section)
a. Section I- Applicant Personal Information
i.
Fill out each section completely. A Social Security number is required in order to apply
for any individual license within the Department of Business and Professional Regulation.
ii.
Provide the license number that you are applying to reinstate.
iii.
In the Full Legal Name section provide your full legal name as it appears on your Social
Security card. Do not use any nicknames or initials. Please list any aliases or prior
names in the prior name information section.
iv.
Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
v.
Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
vi.
Additional contact information is optional and will be used when the applicant cannot be
reached using their primary contact information.
b. Section II- Explanation of Illness or Economic Hardship
i.
Provide a statement that explains the illness or economic hardship.
ii.
Attach additional copies as necessary.
c. Section III- Affirmation by Written Declaration
i.
Each applicant must sign the affirmation by written declaration.
DBPR BCAIB Reinstate Null and Void Certification
Eff. date: 07/10/2012
Incorporated by Rule: 61-35.008