Inactive Status Request Form

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INACTIVE STATUS REQUEST FORM
Complete this form if you would like to put your license(s) on Inactive status this renewal term.
I ______________________________ as ___________________________
(Name of officer, owner, partner, or member)
(Owner, Partner, Officer, or member)
of ______________________________________________do hereby request the indicated
(Name of company/entity as it appears on license)
license(s) below be put on Inactive status for the regular renewal term of _______________.
(Expiration date of license)
What license(s) do you want to put on inactive status for this renewal term?
Yes___ No_____
Commercial Only
Yes___ No_____
Residential Builder Only
Yes___ No _____
Home Improvement Only
Yes___ No _____
Commercial and Residential Builder
* BOTH licenses will be placed on INACTIVE status
Yes____ No_____
Commercial and Home Improvement
*BOTH licenses will be placed on INACTIVE status
The following is understood by signing this form:
1.)
The indicated license(s) above is NOT ACTIVE
The company above may not, under our law, bid, contract, or perform any
construction projects that would require an Arkansas Contractors License.
2.)
Inactive status may be requested each year at the renewal term. You may request
inactive status yearly for 6 consecutive years and it must be requested yearly at the
renewal term (expiration date).
**Effective January 1, 2012, Act 1208 regarding Home Improvement projects over $2,000
will require either an active Commercial, Home Improvement, or Residential Builder license
with the proper classification(s). **
I have read and understand the information above regarding Act 1208.
_____________________________________
(Signature of officer, owner, partner, member)
STATE OF_______________________COUNTY/PARISH OF______________________
Subscribed and Sworn/Affirmed before me, a Notary Public, this ____ day of ______________, 20____.
_________________________________________
(Notary Public-Signature and Stamp/Seal)
My Commission Expires______________________
Revised 4/2012

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