State Of Arizona Alarm Agent Renewal Form Board Of Technical Registration
Download a blank fillable State Of Arizona Alarm Agent Renewal Form Board Of Technical Registration in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete State Of Arizona Alarm Agent Renewal Form Board Of Technical Registration with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2State of Arizona
Board Of Technical Registration
Alarm Agent Renewal Form
Renewal Fee $130.00
1110 W. Washington, Suite 240
Fingerprint Fee $42.00
Phoenix, Arizona 85007
https://btr.az.gov
(602) 364-4930 FAX: (602) 364-4931
All areas of this form must be completed renewal will
be returned and may result in penalty fees being added.
Please complete the following:
Employer:
Home:
Name:
Name:
Email:
Email:
Address:
Address:
City,State,Zip:
City,State,Zip:
Phone:
Phone:
Please Return This Renewal Form With Your Payment For:
Registration No:
Renewal Fee :
$ 130.00
Current Expiration Date:
Fingerprint Fee :
$ 42.00
Any renewal fee received after the expiration date shown will be
Penalty :
subject to a penalty fee. The penalty fee is $21.68 during the first
Total Submitted :
$ 172.00
12 months of delinquency.
Questions to be completed by all registrants:
If the answer to any of the following questions is "yes," please attach a detailed explanatory statement (use additional sheets if
necessary) and related official documentation. Since your last renewal:
1. Have you been refused or denied any registration, certification, license or permit in any state or
Yes
No
jurisdiction?
. Has any registration, certification, license or permit of yours been cancelled, suspended
Yes
No
revoked in any state or jurisdiction?
3. Have you been the subject of professional disciplinary action, or do you now have
Yes
No
such action pending against you in any state or jurisdiction (including Arizona)?
4. Have you been the subject of any type of action by a regulatory agency, or do you
Yes
No
now have such action pending against you in any state or jurisdiction (including Arizona)?
5. Have you been known by a name or names other than the one shown on this application?
Yes
No
If "yes," please state the name(s) _______________________________________________
6. Have you been convicted of a misdemeanor other than a minor traffic violation?
Yes
No
("Set aside" or "expunged" convictions and "no contest" or "nolo contendre" pleas MUST be reported.)
7. Have you been convicted of a felony? If “yes”, you must have obtained and absolute
Yes
No
Discharge from the court at least five years before submitting this application to the Board
("Set aside" or "expunged" convictions and "no contest" or "nolo contendre" pleas MUST be reported.)
I certify the information contained in this application is accurate, true and complete to the best of my knowledge.
Making a false unsworn statement is a misdemeanor punishable by fine or imprisonment. A.R.S. 13-2704.
Signature:
Date:
Interoffice Use Only
Receipt Number:
Amount Paid:
Date Received:
Page 1 of 2
Revised 10/29/2014
ADVERTISEMENT
0 votes
Related Articles
Related forms
Finra Broker-dealers Limited Securities Agent Renewal Form - Division Of Securities Of Department Of Financial Institutions Of State Of Wisconsin 2007
Legal
Form Fc-8r - Application For Renewal Of Corporate Name Registration For Foreign Corporation Form - State Of Montana - Secretary Of State
Legal
Form Lp-7 - Application For Renewal Of Registration Of Limited Partnership Form - State Of Montana - Secretary Of State
Legal
Form Abn-1 - Application For Registration Or Renewal Of Assumed Business Name Form - State Of Montana - Secretary Of State
Legal
Related Categories
Parent category: Life