Sed 9-L - Application For State Electrical License Renewal
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S
N
TATE OF
EBRASKA
S
E
B
TATE
LECTRICAL
OARD
Randy Anderson
Executive Director
S
E
D
APPLICATION FOR
TATE
LECTRICAL
IVISION
800 South 13th, Suite 100
P.O. Box 95066
ELECTRICAL LICENSE RENEWAL
Lincoln, Nebraska 68509-5066
Phone (402) 471-3550
Dave Heineman
Governor
Your 2009-2010 State Electrical License or Apprentice Registration expires December 31, 2010.
1. Complete this form legibly with the information requested.
2. Attach copies of Board approved Continuing Education Certificates totaling at least 12 contact hours, with a minimum
of 6 hours on the NEC. Not required for Apprentice renewal.
3. Attach completed United States Citizenship Attestation Form.
4. Attach the proper renewal fee, and mail all to the address below.
Or ON-Line Renewal Available with Credit Card Payment at
Continuing Education Certificates and United States Citizenship Attestation Form must be sent to the Electrical
Division before renewing on-line.
The holder of an expired license may renew the license until March 31, 2011 upon payment of the license fee plus 10% of
the renewal fee for each month or portion there of past the expiration date. After March 31, 2011 a license holder will be
required to pass an examination before the license is issued.
Issued before
Issued on/after
I request renewal of the license indicated below:
January 1, 201 :
1
December 31, 2010:
■ ■
Electrical Contractor
$130.00
$250.00
■ Class A Master
$130.00
$250.00
■ ■
Class B Electrical Contractor
$130.00
$250.00
■ Class B Master
$130.00
$250.00
■ ■
Journeyman Electrician
$25.00
$50.00
■ Residential Journeyman Wireman
$25.00
$50.00
■ ■
Class B Journeyman
$25.00
$50.00
■ Fire Alarm Installer
$25.00
$50.00
■ ■
Special: Check Type Of License:
■ ■
■ ■
■ ■
Heating/AC/Refrigeration,
Water Well,
Sign Installer
$25.00
$50.00
■ Installer-Residential Appliances Only
$25.00
$
50
.00
■ ■
Apprentice Registration
$20.00
$40.00
My 2009-2010 State electrical license or registration number is:
Last four digits of Social Security No.
Name (Print or Type)
No. & Street
Town
State
County
Zip
Company Name
Amount Enclosed __________________
sign
here
Make check payable to the State Electrical Division
Note:
This form may not be used to upgrade a present license. State electrical examination is available to
any qualified applicant wishing to obtain a license of higher class. Any attempt to upgrade a license
on this form will delay processing.
NOTICE
PLEASE PROVIDE ALL INFORMATION
FOR ACCURATE PROCESSING
STATE ELECTRICAL DIVISION
800 SOUTH 13TH, SUITE 100, P.O. BOX 95066, LINCOLN, NE 68509-5066
An Equal Opportunity/Affirmative Action Employer
SED 9-L 9/10
Printed with soy ink on recycled paper
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