Application and Affidavit for Duplicate Mobile Home Installer License
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APPLICATON/AFFIDAVIT FOR DUPLICATE
MOBILE HOME INSTALLER LICENSE
Date:
License Number
Installer’s Name
Installer’s Address
I certify that the license described herein has been lost in transit and never received by me, or
that the original license issued in my name has been lost or destroyed.
I further certify that if the original license is found or received, I will immediately return it to the
Mobile Home Installer Licensing Section, Division of Motorist Services at 2900 Apalache e
Parkway, Neil Kirkman Building, MS 66, Tallahassee, Florida 32399-0640.
Installer’s Signature
---------------------------------------------------------------------------------------------------------------------
(GHQ USE ONLY)
Receipt Date
License reflecting forms control number
printed and mailed to mobile
home installer at above address on
.
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