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Unformatted text preview: My Email Address is: _______________________________________________ Check here if: b I am a licensed professional in Vermont. b I am a nurse applicant (original or retake) not yet licensed. If the following applies, check the box: b I was represented by an agency, and now wish to be listed as an individual, please update my address and file as above for all correspondence. I understand that It is unprofessional conduct for a licensee to fail to notify the Secretary of States Office of a change of name or address within thirty (30) days (3 V.S.A. 129a(a)(14). Signed ____________________________________Date __________________ 7/28/09...
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This note was uploaded on 12/10/2011 for the course ACCT Accountanc taught by Professor Jenkins during the Spring '11 term at Sacread Heart University.
- Spring '11