Have you obtained a high school diploma or the equivalent of a high school Diploma? 9. Type of Exam/License Applying for: (circle one) Operator Instructor Manicure Specialist Instructor Facial Specialist Instructor Eyelash Extension Specialty Instructor 8. Box Number City State Zip Code Country FAX Number: ( ) ( ) Area Code Phone Number Area Code Phone Number E-mail Address for example) 7. Box is allowed for this address.) Number, Street and Apt. Mailing Address and Contact Information: (USED FOR ALL CORRESPONDENCE) (P.O. Gender: Month Day Year MALE (circle one) FEMALE 6. Do you have a Social Security Number? (circle one) YES NO 4. The SSN that is provided is confidential and is required to enforce Child Support orders. Applicant's Social Security No.: _ _ _ - _ _ - _ _ _ _ Note: If you have a Social Security Number, Section 231.302 of the Texas Family Code REQUIRES all applicants to disclose their Social Security Number (SSN) when filing an application. Applicant's Full Name: EXPIRED LICENSE EXPIRATION DATE: Last (Family Name) First (Given Name) Middle 2. AMOUNT MONEY TYPE EXPIRED LICENSE NUMBER: 1. Box 12088 - Austin, Texas 78711-2157 (800) 803-9202 - (512) 463-6599 - FAX (512) 475-2871 - APPLICATION FOR: Application For An Expired Texas Cosmetology Instructor License PURSUANT TO, OCCUPATIONS CODE, CHAPTER 1602 DO NOT WRITE IN THE FEE AREA IMMEDIATELY BELOW EVENT CODE FEE AMOUNT FEE RECEIPT NUMBER License Fee $70.00 PMT. TEXAS DEPARTMENT OF LICENSING AND REGULATION P.O.
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