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License Fee Waiver Request

If your agency or organization would like to waive any license fees, please complete this application and submit the appropriate documentation.

Position Title
Agency Admin
Board Member
Executive Director
Finance Manager
Other
Please select all funding types your agency receives

Please submit a letter on your agency's letterhead requesting a license fee waiver and explaining the reason. Ensure your signature is at the bottom of the letter.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

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