image
Public Information and Records Request

Public Information and Records Request

Requester Information

Records Request

   If you need a list of licensee information for marketing or commercial requests, please fill out the Records Reproduction Request Form. 

   If you need a license verification for moving out of state, please see our website

   If you are checking on your application or have a general question about your license or renewing, please fill out the General Questions form
 


Please attach any additional information that would help us process your request.
Unlimited number of files can be uploaded to this field.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
CAPTCHA
Enter the characters shown in the image.