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TEXAS STATE BOARD OF PLUMBING EXAMINERS

PO Box 4200 • Austin, Texas 78765-4200

(512) 936-5248

REQUEST TO RELINQUISH RESPONSIBLE MASTER PLUMBER DESIGNATION (RMP)

Please note: Only the licensee may make this request. This request form must be completed and signed before a

notary public and returned with payment of $10.00. If the request is made in person, a Notary signature is not

needed, however, a valid State issued photo ID is required. Please allow 10-14 days for processing and to

receive your replacement Master Plumber License card without RMP designation. If submitted along with your

regular renewal form the $10.00 replacement fee does not apply.

Last name: ________________________ First name: ___________________ MI: _____________________

Master License Number: __________________________DOB: ____________________________________

Address ____________________________________________ City ______________________ ST.________

Zip ________ Daytime Ph. # ___________________ DL or State issued ID# __________________________

Why are you relinquishing your designation as a Responsible Master Plumber: ______________________

I understand that submitting any false information to the Board may result in disciplinary action, up to

and including revocation of my license and/or an administrative penalty not to exceed $5,000. I

understand that the penalties for perjury or tampering with a governmental record through false entry of

information may consist of (1) a fine not to exceed $4,000. (2) confinement in jail for a term not to exceed

one year; or (3) both such fine and confinement.

Furthermore, I understand there are no refunds or partial

refunds based on when the designation was obtained or relinquished.

In addition, I understand that

offering to perform or contracting for plumbing work without first securing the services of a RMP is a

violation of law and I may be assessed a penalty if found in violation.

By signing this form, I hereby affirm that all of the facts, statements, and answers contained herein are

true.

Signature of licensee making request _________________________________________

Date_____________

Before me, the undersigned authority, personally appeared _____________________________, who has

identified themselves through a drivers license or state issued photo ID.

SWORN TO AND SUBSCRIBED before me, the undersigned authority, on this the ___________

day of _______________________, ___________.

_____________________________________

SEAL

Notary Public in and for the State of Texas

Office use only: Fee type/amount ___________________ Date rec’d ________________ Initials _______Entity number ______________________

Date processed _____________________

RRMP FORM 2/2014

February, 2014

Request To Relinquish Responsible Master Plumber Designation (Rmp) - Texas State Board Of Plumbing Examiners