Professional Photocopier Registration Template printable pdf download

(File Stamp)

State of California

County of Yolo

Term of Registration: 2 years

(see reverse for more information)

CERTIFICATE of REGISTRATION as a PROFESSIONAL PHOTOCOPIER

Individual, Corporation or Partnership

(Business & Professions Code Sections 22452, et.al.)

(check one)

New Registration

Renewal Registration

The undersigned declare(s): _____________________________________________________________________________

(Name of Individual, Corporation or Partnership)

is:

an individual

_____________________ corporation

partnership

(State of incorporation)

a) The application for registration of a natural person shall contain all of the following statements about the applicant:

(1) Name, age, address, and telephone number.

(2) He or she has not been convicted of a felony.

(3) He or she will perform his or her duties as a professional photocopier in compliance with the provisions of law governing

the transmittal of confidential documentary information in this state.

b) The application for registration of a partnership or corporation shall contain all of the following statements about the applicants:

(1) The names, ages, addresses, and telephone numbers of the general partners or officers.

(2) The general partners or officers have not been convicted of a felony.

(3) The partnership or corporation will perform its duties as a professional photocopier in compliance with the provisions of

law governing the transmittal of confidential documentary information in this state.

c) The applicant shall be a notary public or work under another person who has a notary public commission in the state of California.

Notary Public’s name: ___________________________________ Commission Number: _______________________

If the notary commission is held by someone other than the registrant, written confirmation from the notary authorizing the

use of their commission for this registration is required.

Registration in the County of Yolo is proper because the principal place of business is located in this county at:

Physical Address

City

Zip

Each of the undersigned declare(s) under penalty of perjury that the foregoing is true and correct except for the personal information

contained herein; and, as to that personal information, each declares under penalty of perjury that personal information is true and correct

only to the extent that it applies to him / her. (Attach page(s) for additional partners or corporate officers, if necessary.)

Name / Title __________________________________________________________

Age _______

Phone ____________________

Address ______________________________________________________________ Signature _______________________________

Name / Title __________________________________________________________

Age _______

Phone ____________________

Address ______________________________________________________________ Signature _______________________________

Name / Title __________________________________________________________

Age _______

Phone ____________________

Address ______________________________________________________________ Signature _______________________________

Name / Title __________________________________________________________

Age _______

Phone ____________________

Address ______________________________________________________________ Signature _______________________________

Office Use Only:

Registration # ____________________

Expiration Date _________________

#ID Cards Issued_________

Document # (Bond) _________________________

Recorded Date ______________________

Initials ______________

Professional Photocopier Registration Template

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