![Page 1: DUMBER - michellawyers.commichellawyers.com/wp-content/uploads/2017/12/doj-regular.pdf · FINAL TEXT OF REGULATIONS California Code of Regulations Title 11, Division 5 Chapter 10](https://reader031.vdocument.in/reader031/viewer/2022030404/5a7a2d657f8b9a01528b693f/html5/thumbnails/1.jpg)
STATE OP CAItFORNIA~*OPFKEOFADMINISTMTNEtAW ~. ~~'~.~ ~" ~.v, ~ ~. ,': f ,--~~ `---..
NQTICE PU$LICA~'IC1Nf REGUCt~T~~i~tS SUBMISSION $~ ~nstr'ucttons an For use by Secretary of Stake onlyreverse)
OAL ~(L~E NOTICB FILE ►DUMBER EGUtATORY ACI10 NU B R EMERGENCY NUMBER~~~~~~ Z.zQ,•4703-4, ~ ~ a ~ s,-- _ . _ _._ e...~~ ~.. ~~__ _.._._._~_._., _ . _ .~... __._ _._.,_.
Nnnc~
AG~~y WI1'#1 RU~EMAKING Af171
Department of Justice
RECiUU4Ti0NS
A. PUBGiCATIQN OF NQTICE (Camp~et+~ fir publ€cation i» Notice Register}
•~ ~~.+ w~-i ~ •••• .,,. c. n ~~GY I'Y~LIW1fIV{`1-YM~G
3. N0710E tYPE A, AGENCY CONTACT PERSON TELEPHONE NUFAB@R p pne~)
❑Noklce re ProposedR Mato Action ~~er
OAL USE Q" ~ ~~ NQ17CQ EGI$ NUMBER PU UCq !ON A
OPILY ~WDsOYOd "~ APPrvvad as 0lsaPProvedl ~,~,y.M.~ _ ---_.B. SUBfVtlSS[dN OF REGULATIQWS (Complete when submitting regutatdanx}
ta, SUBJECT OF' REGULATION(9} 16. Att, PREVIOUS RELATED QA~ REGULATdRY ACTION NUMBERS)
Ammunition Vendarlicenzeing
Z SPECiFYCALIFOiiNIAL00EOFREGllIATIQN5TfT3.Ei5)ANDSfLTIdNtS) {Indudlnptlllt2QittoxlnedaNdi
SEC'f10[VISi'AFF~tTED ,•""`~~~l.ise I II section number{s) 426tt, 4261, 4262, 42b3, 4264
inddvlduaEiy.Attech nM Nt~
addl~ioesaE sheet if needed.}Ti'i`I.E(S) REP
~~
3. SYPE OF FILING
❑X RegularRulemaking (Gov. p ~ ~ g ry p Chan es 4Yithaut He ufato~ Cettiticate of Com 1lante; The a en officer named Emer en Reado t {Gov.Codp 511346) 9 g rybelow certifies that this agency comptfed with the Gode, 57 i3a6.tlh)} ~ Hffect (Cai. Code Regz., dtlgQ Resubmlttal otdisapproved ar p~avlslons of Gov. Code 4§113A6,2~113473 either ~ y~~~withdrawn ngneme[gency 6eiore the emergency regulation was adopted ar Ffle &Print Print Onlfiling (Goo, Code 541134 .3, within the time period requtred 6ystatute. ~ ❑ YS 1349.4)Emergency 1Gov. Code, ~ Resubmfttal of disapproved or withdrawn ~ Other (Specify}411348,Tib)) emergencyflling(Gov.Code, 51t346,i)
NIA$EGINNtNGANflENDING6ATESDFAYAI6ABILfTYOFMODIFtE~REGULATiONSAHDlOBMASEItIAIADDEDTOTHERULEMAKINGFILE(CxI.CWeRegs.UUe1,544 andGov.Cale 41tJ47.i)
3. EFPECTNEpATEOPCNANGES{Gav,Godr.S511343A, it3ifi.1idl;Cal.Codepegc,NUe 1,5100)En~~ ewro~ur ~.,4nru ~. July t. ~ ~reew,~ n~, r~~,Q w~u~ Stoo Chmges Without kp~Yg p~cember 31, 20 i 7Odo6et i tGov, Code S1 t343.A{e}) Q ~ap~~. at Slote ❑ Regulatory fHep a other {Sp~cftY)
& CHECK IF THESE REGULA7]pN5 RBOUIRE NOTICE 7Q OR REVIEW, CONSULTATION, APPROVFd.4R CONCURRENCE 8Y. ANOT}iER AGENCY OR EtJ'4'ITY
o Department of Finance;Form STD. 349) tSAM §bEr60) ~ fair PaitSical Practices Commission ~ Stata Pfre Marshal
n Other (SpectEy)
I~~n~~alina Tlnc~h
request ~~R~ ~~Jj~ ~~? "~: ~..~ .~ ~,;
-~ ,
Sean McCluskle, Chief Deputy to the Attorney General
8• 1 cert;#y;hat thq attached copy of the regulation(xj {s n true snd correct copy ~~~ use by Once of Admfnfstrative Lew {aAl) only
of she reguiatia»{s) identified ate this form, that the ir~formatian specified an this formis trae and correct, and that ! am the head at the agenty taking thEs action, ~Iar designee o#the head of the agency, aid am authorized to make #his cereiflca#Tan.
SI~NA E DF AGENCY HEAD OR DESIGNEE GATE
~'V` r C.~.~,~t_ ~ I1 ~.3 ~1 ~ 17
![Page 2: DUMBER - michellawyers.commichellawyers.com/wp-content/uploads/2017/12/doj-regular.pdf · FINAL TEXT OF REGULATIONS California Code of Regulations Title 11, Division 5 Chapter 10](https://reader031.vdocument.in/reader031/viewer/2022030404/5a7a2d657f8b9a01528b693f/html5/thumbnails/2.jpg)
FINAL TEXT OF REGULATIONS
California Code of Regulations
Title 11, Division 5
Chapter 10. Ammunition
,~ 4260 Ammunition Vendor License Applications
~a~~plicants for an initial ammunition vendor license must complete and submit Department
of Justice Ammunition Vendor License Non-Firearms Dealer, form BOF 1021 (Orin. 01/2018),
which is hereby incorporated by reference. The application must be submitted with the fee
specified in section 4261 and a copy of the following:
~1) And u~ i~atory or business license required by local government.
~2) Valid seller's permit issued by the State Board of Equalization.
(3) Federal Firearms License if the applicant is federally licensed.
~4) Certificate of Eli ibilit~
(b) Applicants for renewal of an ammunition vendor license must complete and submit
Department of Justice Ammunition Vendor License Renewal Fee Transmittal, form BOF/CAV-
0012 Orin Ol/2018~, which is hereby incorporated by reference with the fee specified in
section 4261.
t,c) A firearms dealer licensed pursuant to Penal Code sections 2b700 to 26915 is automatically
deemed a licensed ammunition vendor pursuant to Penal Code section 30385(d) and is not
required to submit an application for an ammunition vendor License.
Note• Authority cited• Sections 30385 and 30395 Penal Code Reference: Sections 26700, 30385, and 30395, Penal
Code.
~ 4261 Azninunition Vendor License Application Fee and Term Length
(a) The annual application fee for an ammunition vendor license (initial and renewal) is $198
per location if the vendor is not on the Centralized List of Firearm Dealers.
(b) The term of an ammunition vendor license is from January 1 through December 31,
regardless of the date the initial license is issued.
~c) Ammunition vendors must submit to the Department of Justice a copy of renewals of the
licenses specified in section 4260 within 30 days of the license's expiration. Failure to do so will
invalidate the ammunition vendor license until a co~,~of the renewed license is received by the
Department of Justice.
~d) ammunition vendor licenses will be automaticallX renewed for vendors wha maintain
active status an the Centralized List of Firearms Dealers.
Page 1 of 2
![Page 3: DUMBER - michellawyers.commichellawyers.com/wp-content/uploads/2017/12/doj-regular.pdf · FINAL TEXT OF REGULATIONS California Code of Regulations Title 11, Division 5 Chapter 10](https://reader031.vdocument.in/reader031/viewer/2022030404/5a7a2d657f8b9a01528b693f/html5/thumbnails/3.jpg)
Note: Authoritycited: Sections 30385, 30390, and 30395. Penal Code. Reference: Sections 30385, 30390, and
30395 Penal Code.
4262. Display of Ammunition
Pursuant to Penal Code section 30350, ammunition shall not be displayed for sale ar transfer in a
manner that allows that ammunition to be accessible to a purchaser or transferee without the
assistance of the vendor or an employee of the vendor. Ammunition displayed in a shopping area
open to the~ublic is not considered "accessible" provided it is in a locked container (e.~. display
case, cabinet, cage).
Note: Authority cited: Sections 30347 and 3Q350, Penal Code. Reference: Sections 30347 and 30350, Penal Code.
& 4263. Vendor Fee for Processing a Private Party (non-vendor) Ammunition Sale
In addition to any applicable Department of Justice fee, an ammunition vendor may char e the
purchaser a feed) for processing the sale of ammunition between two private parties as follows:
(a) If the ,purchaser wzll be present for immediate delivery of the ammunition, the fee shall not
exceed five dollars ($5~
fib) If the purchaser will not be present for immediate delrvery of the .ammunition, the vendor
may charge an additional storage fee as a ig eed upon with the purchaser prior to the vendor
receiving the ammunition.
Note: Authority cited: Section 30312 Penal Code. Reference: Section 30312, Penal Code.
4264. Suspension and Forfeiture of Ammunition Vendor's License
a) An ammunition vendor's license may be suspended for a period of up to six months for a
violation of these regulations.
(b} An ammunition vendor's license may be forfeited for a breach of any of the prohibitions
and requirements in Penal Code sections 30300 through 30365.
~) A11 hearings related to a suspension or forfeiture shall be conducted in accordance with
Government Code section 11500 et. seq.
~d) An ammunition vendor whose license is forfeited may not re-appl~for a license earlier
than one mar from the effective date of the forfeiture.
Note' Authority cited Section 30395 Penal Code. Reference: Sections 30300 30305. 30306, 30312, 30314, 30342,
30345 30347 30348 30350 30352 30355 3Q357 30360 30362 30363 30365 and 30395 Penal Code.
Page 2 of 2
![Page 4: DUMBER - michellawyers.commichellawyers.com/wp-content/uploads/2017/12/doj-regular.pdf · FINAL TEXT OF REGULATIONS California Code of Regulations Title 11, Division 5 Chapter 10](https://reader031.vdocument.in/reader031/viewer/2022030404/5a7a2d657f8b9a01528b693f/html5/thumbnails/4.jpg)
:• i/ i'•• 1 Ji ''~'
~,,f; i• i~tl):~ ~ 1 ~ ~ ♦ r l ~ ~ ~;~AT.i~gyF,4~q s
~l . Oe
1.:. 4
~. ~
M~ :.~ :*
i ~' ♦ +F ~ ~S r ,~~"h . ~.:
mmun ion en or ar ustness n~ty ame
treat ress ~ty ounty t~ ate~ae
ai ing ress r i Brent ty ~:ounty ~ ~~od-e
usrness may ress e ep one urn er ax um er
Hours of Gyperation
Monday _l'uesday Wednesday Thursday Friday Saturday Sunday
to to to to to to to. ! ! /. I I )
Loca! Ammunition Vendor Licensing Authority {issuer of lacat business license)
focal Law ErrFarcement Rgency {police or sheriffs department)
Piease indicate the type of business ownership:
(~ Individual Owner/Safe Proprietor Q Limited Partnership ~ Corporate Ownership
~ Limi#ed .Liability Company [~ General Partnership ~ Limited Liabili#y Partnership
OPTiC1tUAL: Please. provide the name, Title, address, phone number, and email address of the applicant's agent for service ofprocess. in the State of Cafifarnia.
Name ~ Title
treet ress qty unty gate Z~p~e --
rrra~ ress e ep one um er ax um er
OPTIONAL: Please provide the name, title, address, phone number, and email address of the person to contact for.clar~cafian of infarmatian provided in this application package:
Name Title
#reef ress qty unty .,t e i~o3e---
Email Address Telephone Number Fax Number
![Page 5: DUMBER - michellawyers.commichellawyers.com/wp-content/uploads/2017/12/doj-regular.pdf · FINAL TEXT OF REGULATIONS California Code of Regulations Title 11, Division 5 Chapter 10](https://reader031.vdocument.in/reader031/viewer/2022030404/5a7a2d657f8b9a01528b693f/html5/thumbnails/5.jpg)
e s. ~ i~ • al; ~ .~.
,r,~cfp.t: , a ~ ~ 1 ` ~ ! ~ ~; 5
EFT7pgY~•r4F^5;.., j,. . o. H
t._~, ~ C;; t
~. ~:
.. ',~ Yv' ~ • i • f
t 7~l..i ~~;t~ ♦ ~..: I ~ * ~ . ~ ~
4~PAIilF1E~tS
Part B -Ammunition Vendor Licensee dnfocmation
icensee ame espons~ e arty {as d appears an a i orn~a driver icense or i ent~ icat~on car
e ~cate o ig[ ~ qty um er xp~rat~on ate
e era ~cearms ~cense um er applica e) p~rat~on ate
oca usiness ~cense um er piration ate
t er aca License um r xp~ration ate
a omia oar o qua izat~or~ e e s erm~t um er
Part C - Additia~na6 Arnrr~unitivn ~~ndor L~c~~see(s)Please complete 8h1s sec8on if fher~ is rr~ore khan one !lcenseel~esponsible party wltf~ a Ct~~ and l.~C far the .4rrrmur~itfon OJer~dor►isrec~ above.
Licensee NamelResponsible Party {as it appears on California driv~*r license or identifica#ion card}
COE Number COE Expira#ion Date
Licensee Name/R~spr~nsibte Party has it appears. on California driver license ar identifiaatian card)
CAE Number GOE Expiration Date
Licensee Name/Re~ponsibte Party {as it appears on California driver license or identification card)
COE Number COE E~cpiration Date
![Page 6: DUMBER - michellawyers.commichellawyers.com/wp-content/uploads/2017/12/doj-regular.pdf · FINAL TEXT OF REGULATIONS California Code of Regulations Title 11, Division 5 Chapter 10](https://reader031.vdocument.in/reader031/viewer/2022030404/5a7a2d657f8b9a01528b693f/html5/thumbnails/6.jpg)
:• n •a ~
r .,:, ~.
~ a' ! e
..y~'~;`,~,rtl rite"~~\~ ~ j: — • ! — • ~
Part i~ - Emplo~ree ̂ ertific~te of eligibility lreforrr~at~a~nPhase comp/ere this secifc~n for every employee wri~tB~ a COE u+ho who w~!! be handdin~, selling, a~elfverfng, or O~ave under his/hercersrody or contra► any ammunition.
mp oyes arne as it appears ora a ornia dnver rcense or ~ anti capon car )
um er xpiration a#e
mp oyes ame as it appears on a r omia aver ~cense ar i ant ~ca~on car )
um er xp~ration ate
mp oyes, ame as it appears: on a omia ever ~cense or a ant canon car
um er C xpirat~on ate
art ~ - ~~rti~i~tior~ ~
1 dec{ace under penalty of penury under the laws of the State ofi California #hat the foregoing is true and correct.
nrrte ame icsnsee esponsi e at~iy iste ~n art ~gnature ate
nnte ame ioensee espons~ e arty ~sf in art Ngnature ate'—
nnte ame icensee espons~ e ar#y ~sf m art ~gnature ate ~—
nnted ame tcensee espc~nsi e arty Est m art ignature ate ~e
~~rt ~ _ ~~es ____
Ammunition Vendor License Annual Fee: $198
Please make a check or money order payabie to the Department of Justice. Mail check and completed application #o thebelow address:
Depat#ment of JusticeBureau of Frearms -Ammunition Vendor Licensing Unit
P.U. Box 16D487Sacramento, CA 95816-0487
![Page 7: DUMBER - michellawyers.commichellawyers.com/wp-content/uploads/2017/12/doj-regular.pdf · FINAL TEXT OF REGULATIONS California Code of Regulations Title 11, Division 5 Chapter 10](https://reader031.vdocument.in/reader031/viewer/2022030404/5a7a2d657f8b9a01528b693f/html5/thumbnails/7.jpg)
STATE O~ CAIIF~iN1A OEPAR7iu~►T ~ JtlSTiCfeaF ioz~ Ems: o~no18) PAGE A of b
Appl[catian forAmmunition Vendor. License {Nan-Firearms Dealer)
~~ [~tSTRUCT1ti~1S ,~
$pnlication Requirem~nt~Applications for an ammunition vendor License must be typed or printed in ink Incomplete appficatians will not be procQssed and wi(t bereturned with all required fees.. AppEiGations must be accompanied by copies. of the Federal Firearms License (FFL} (if applicable}, Local
Business License {LBL), the Board of Equalization's Seder's Permit for each individual identified as a licensee in conjunction with thebusiness, and a listing of a{t employees w~h a certifica#e of eligibility {CUE}. #f you. have any questions, please contact the Bureau of
firearms at (916j 227-2685.
Pitt A -Ammunition Vendor or ~uslrress EnCrty Information
• Provide the ammunition vendor or business entity name, telephone number, fax number, physical location, mailing address, andbusiness. email address. The physical location information is frequently different when a past ofFce box or a rural route numberis used as the mailing address.
• Provide type of business ownership.
• Name, title, address, phone number, and email address ofi'the applicant's agent #or service of process in the State of Galifomia..Please reference webiink ht~p•/lwww sos ca gov/business-programslbusiness-entities/se~yice-processl for more informationregarding service of process.
• hfame, title, address, phone number, and email) address of the person to contact for clar9fica6on of in#ormation provided in thisapplication;package.
• Provide the ammunition vendor's hours of operation far each day of the week listed, .using hh:mm AM/PM format:
Provide the Local ammunition vendor licensing authority's name, along with the name of the. police or sherifF'sdepartment that is responsible for law enforcement protection in your community.. The local licensing authority is the localdepartment or bureau that issues the local ̀business License in your jurisdiction.
dark ~ - Arnrnun~t~oa~ ~lencior ~icense~ Ir~forrt~ation
:Provide the licensee name/responsible party as it appears on his/Fier California driver license or ident~cation card, along with'their corresponding (COE), (FFL) (if applicable), and (LBL), numbers and expiration dates. The Board of Equalization Seller's..Permit number must also be provided.
Pert ~ - Adclitiona~ ~r~rnun6tion Yenda~r licensee
• Each additional licensee/responsible party who is listed on the FFL (if applicable), LBL, and Board of Equalization Selle►'sPermit, and who desires to be identified as a responsible party for this business must also provide his/her name as i# appears ontheir California driver license or identification card along with their corresponding COE number and expiration date. Part C maybe copied to accommodate as many additional licensees as necessary.
i~~~i ~ - cmp~i~~/~~ C~►~ifl~it~ ~t Eiigibliit~' Infoc~nat~ora
• ~o~ each agent csr ernplay~~ who has acc~s~ t~ a~mt~rition far this business, the licensee must provide the ~gent'~ oremployee's name as it appears on their California driver license or identification card along with their corresponding CC)Enumber and expiration dale. Part D may be copied to accommodate as many additional employees as necessary,
Part ~ - ~ignat~res
The licensees) must sign and date the certification statement affirming the informafian provided is true and correct. Part E maybe copied to accommodate as many additional signatures as necessary.
• Thy ammunition vens#or license fee is 5+998.
Make check or money order payable to the Department of Jusfice for the appropriate remittance. Attach the check
or money order to the lower ~ght margin of the form.
• Mai! the completed applicafian, remi~ance and required. documentation to the below address:
Depaitrnent of JusticeBureau of Firearms -Ammunition Vendor Licensing Unit
P.O. Box '!60487Sacramento, CA 95816-0487
Allow 30 business days for processing initial applications.
![Page 8: DUMBER - michellawyers.commichellawyers.com/wp-content/uploads/2017/12/doj-regular.pdf · FINAL TEXT OF REGULATIONS California Code of Regulations Title 11, Division 5 Chapter 10](https://reader031.vdocument.in/reader031/viewer/2022030404/5a7a2d657f8b9a01528b693f/html5/thumbnails/8.jpg)
STATE OF CALIFORNIABOF l02t i~9.01l2A18)
-,~}~~r
~~ As Required by Civil Code § 1798.17
Collection and Use of Personal, tnformatiot~: The Division of Law Enforcement in the Department ofJustice co[lec~s fhe information requested on this farm as authorized by Penal. Code section 30385. TheDivi~ an of ~.aw Enforcement uses this. information to establish grounds for the issuance of the license orpermit indicated on this. applicafron. to addition, any personal infiormatian collected. by state agencies issubject to fhe limitations in the Informs#ion Practices Act and state policy. The Department of Justice'sgeneral privacy policy is available at hit :lloag.ca.c~ov/.privacy-polio.
Providi~tg Personal t~tformatcon: All the personal information requested in the form must be provided.If you #ail to provide. any of the required persona! informs#ion, the unprocessed report will be returned toyou. for comp(e#ion and resubmission.
Access to Your fn#armation: You may review the records maintained by the Division of LawEnforcement in the Department of Justice that contain your personal information, as permitted by the)nfarmafian Practices Apt. See below fc~r contact information.
Possible ~isclasu~e of Persor~a~ in~ort~tatian: to order to ensure. you. are not prohibited and establishgrounds for the issuance of the license: or permit indicated can this application, w~ may need. to share theinformation you give us with entities as authorized in Penal: Code section 1 '! 105. The informs#ion youprovide may also be disclosed in the fallowing circumstances:
ifh c~th~r persons Qr agencies where necessary tc~ perform their legal duties, and (heir use ofyour ir~farmation is compatible and complies with sfiate Eaw, such as for roves#igations or for.licensing, certification, or regulatory purposes;
■ To anr~ther government agency as required by state or federal law.
C~► t~+~t Inf~rm~tian: For questions about this. notice. or access to your records, you may con#act theStaff Services Analyst ~n the Gus~omer Support Center afi (916) 227-7527, via email atfir~arms.bu~-eau(c~daj~~c~v, or by mail a# P.Q. Bcx 9~i0487, Sacramento, CA 95816-0487,
![Page 9: DUMBER - michellawyers.commichellawyers.com/wp-content/uploads/2017/12/doj-regular.pdf · FINAL TEXT OF REGULATIONS California Code of Regulations Title 11, Division 5 Chapter 10](https://reader031.vdocument.in/reader031/viewer/2022030404/5a7a2d657f8b9a01528b693f/html5/thumbnails/9.jpg)
BOF/CAV-0012 (Orig. O1/2018) 1~.D(~FT
CALIFORNIA DEPARTMENT' 4F JUSTICEAmmunition Vendor Licensing Unit
Ammunition Vendor License Renewal Fee Transmittal
<Business Name> Vendor:<Address><City, CA Zip>
Total Annual Fee:
InstructionsMake any .business information changes next to the line number that requires correction. If nochanges aremade, indicate no change by checking the appropriate box..All licensees must signand date the renewal form. Submit. the: signed form. and fee to:
Department of Justice$ureau of Fia-earms —Ammunition Vendor Licensing Unit
P.O. Box 1604$7Sacramento, CA 95816-0487
1. Ammunition Vendor/Business ~nfarmation:a. ~n~nunition Vendor Numberb. Business Telephone Numberc. Business :Fax Numberd. Physical Addresse. Mailing Address. (if different)£ Business Email Addxess
2. Days and Hours. of Operation.3. Business Type4. Agent far Service of Process Information:
a. Name
b. Title
c.. Physical Addressd. Telephone. Numbere. Email Address
5. Alternate Contact Person Information:a, Name
b: Title
c. Physical Addressd. Telephone Numbere. Email Address
6. Local Business License Authority1. Local Law Enforcement Agency
Page 1 of 2
![Page 10: DUMBER - michellawyers.commichellawyers.com/wp-content/uploads/2017/12/doj-regular.pdf · FINAL TEXT OF REGULATIONS California Code of Regulations Title 11, Division 5 Chapter 10](https://reader031.vdocument.in/reader031/viewer/2022030404/5a7a2d657f8b9a01528b693f/html5/thumbnails/10.jpg)
$oF~cav-oo12 ~or~g. o.liaols> 1~DOPT
CALIFORNIA DEPARTMENT' OF JUSTICEAmmunition Vendor Licensing Unit
Ammunition Vendor License Renewal Fee Transmitxal
8, Ammunition Vendor Licensees) Information.
a. Names(s)
b. Certificate of Eligibility Numbers)
c, Federal Firearms .License Number (if applicable)
d. Local Business License Nurriber
e. Other Local License Number (if applicable)
f. California Board of Equalization Sellers Permit Number
9. Employee of Certificate of Eligibility Information
a. Names(s) f
b, Certificate of Eligibility Numbers)
c. Certificate of Eligibility Expiration Date
No changes
Printed Name: Signature: Date:
Printed Name: Signature: Date:
Printed Name: Signature: Date:
Printed Name: Signature: Date.
Allow 20 business days to process the renewal.
Please note: Not receiving tt renewal notice does not remove a vendor from responsibility of
.timely payment.
Page 2 of 2