"Registration Renewal Notice - Fire Extinguisher Classification: Branch" - Tennessee

Registration Renewal Notice - Fire Extinguisher Classification: Branch is a legal document that was released by the Tennessee Department of Commerce and Insurance - a government authority operating within Tennessee.

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FOR OFFICE USE ONLY
LICENSE TYPE _____________________
TRANSACTION TYPE _______________
FILE NUMBER _____________________
ENTITY NUMBER __________________
th
500 James Robertson Parkway, 10
Floor
__________
APPLICATION NUMBER
Nashville, TN 37243
Tel: 615-741-2981
AMOUNT PAID ____________________
http://www.tn.gov/commerce/
Name
Date:
Street Address
City, TN Zip
Hydrostatic
Yes
Authorization:
No
Specialist(s) on file: (Supporting
License)
REGISTRATION RENEWAL NOTICE
FIRE EXTINGUISHER CLASSIFICATION: BRANCH
THIS IS THE ONLY RENEWAL NOTICE YOU WILL RECEIVE.
Failure to complete each step outlined below will result in delayed processing and possible expiration of your registration.
This form is to be used for renewals only. New applicants must submit a separate application form.
RENEW ONLINE AT
https://core.tn.gov
OR MAIL THE RENEWAL FORM AND PAYMENT AT LEAST TWENTY ONE
(21) BUSINESS DAYS IN ADVANCE OF THE EXPIRATION DATE. RENEWALS RECEIVED BETWEEN NINETY (90)
DAYS AND TWO (2) YEARS FROM THE EXPIRATION DATE WILL BE SUBJECT TO A LATE FEE. RENEWALS
RECEIVED TWO (2) YEARS AFTER THE EXPIRATION DATE WILL NOT BE PROCESSED AND THE
REGISTRATION WILL EXPIRE.
Expiration Date:
Renewal Fee: $50
If submitted up to ninety (90) days after expiration: $75, hydrostatic $25
Hydrostatic Fee: $25*
If submitted ninety-one (91) days to two (2) years after expiration: $100
*Add to renewal fee if
Hydrostatic $50*
applicable
Step 1:
Step 2:
If your name, mailing address or location has
If your specialist is not the one listed above, enter the new
changed, enter it in the space below (see note):
specialist and file number below:
Specialist:
File Number:
Phone #:
Step 3:
Mail this form with a check made payable to the Department
of Commerce and Insurance.
E-mail:
Note: For a change in ownership, call the number at the top of the page for instructions.
Check here to add hydrostatic testing to your registration. Add an additional $25 to the renewal fee.
I hereby certify I have read and understand the provisions of law relating to the Fire Extinguisher
program. This application is made in good faith, and the answers and statements made herein are
full, correct and true to the best of my knowledge. I understand that any and all information herein
required by the Fire Extinguisher program is considered part of my application.
Applicant Signature: ____________________________
Date: ______________
FOR OFFICE USE ONLY
LICENSE TYPE _____________________
TRANSACTION TYPE _______________
FILE NUMBER _____________________
ENTITY NUMBER __________________
th
500 James Robertson Parkway, 10
Floor
__________
APPLICATION NUMBER
Nashville, TN 37243
Tel: 615-741-2981
AMOUNT PAID ____________________
http://www.tn.gov/commerce/
Name
Date:
Street Address
City, TN Zip
Hydrostatic
Yes
Authorization:
No
Specialist(s) on file: (Supporting
License)
REGISTRATION RENEWAL NOTICE
FIRE EXTINGUISHER CLASSIFICATION: BRANCH
THIS IS THE ONLY RENEWAL NOTICE YOU WILL RECEIVE.
Failure to complete each step outlined below will result in delayed processing and possible expiration of your registration.
This form is to be used for renewals only. New applicants must submit a separate application form.
RENEW ONLINE AT
https://core.tn.gov
OR MAIL THE RENEWAL FORM AND PAYMENT AT LEAST TWENTY ONE
(21) BUSINESS DAYS IN ADVANCE OF THE EXPIRATION DATE. RENEWALS RECEIVED BETWEEN NINETY (90)
DAYS AND TWO (2) YEARS FROM THE EXPIRATION DATE WILL BE SUBJECT TO A LATE FEE. RENEWALS
RECEIVED TWO (2) YEARS AFTER THE EXPIRATION DATE WILL NOT BE PROCESSED AND THE
REGISTRATION WILL EXPIRE.
Expiration Date:
Renewal Fee: $50
If submitted up to ninety (90) days after expiration: $75, hydrostatic $25
Hydrostatic Fee: $25*
If submitted ninety-one (91) days to two (2) years after expiration: $100
*Add to renewal fee if
Hydrostatic $50*
applicable
Step 1:
Step 2:
If your name, mailing address or location has
If your specialist is not the one listed above, enter the new
changed, enter it in the space below (see note):
specialist and file number below:
Specialist:
File Number:
Phone #:
Step 3:
Mail this form with a check made payable to the Department
of Commerce and Insurance.
E-mail:
Note: For a change in ownership, call the number at the top of the page for instructions.
Check here to add hydrostatic testing to your registration. Add an additional $25 to the renewal fee.
I hereby certify I have read and understand the provisions of law relating to the Fire Extinguisher
program. This application is made in good faith, and the answers and statements made herein are
full, correct and true to the best of my knowledge. I understand that any and all information herein
required by the Fire Extinguisher program is considered part of my application.
Applicant Signature: ____________________________
Date: ______________