Application For License Renewal - Salt Lake City (Page 2 of 2) in pdf

Page 2 of 2

ADDITIONAL REQUIRED DOCUMENTATION:

A) If you answered “yes” to question 1, 2, 3, and/or 4 on the first page of this renewal, you must submit complete

documentation – including a personal narrative and any police arrest report, court docket, probation/parole officer report,

diversion agreement, and/or plea in abeyance agreement – for each and every arrest, charge, and/or conviction.

B) If you cannot sign the Affidavit on the first page of this renewal, you must submit a complete written explanation of why

you cannot sign. If applicable, this explanation must include the reasons you have not or will not complete the continuing

education requirements before the expiration or reinstatement of your license. DOPL personnel will reach a renewal

decision on a case-by-case basis after a thorough review of your explanation. Additionally, you may be requested to

provide additional information if the documentation submitted is insufficient.

CHECKLIST FOR TIMELY RENEWAL / REINSTATEMENT BY MAIL:

 Answer all four of the certification questions on page 1 and provide additional documentation, if applicable (#1A above).

 Sign the Affidavit on page 1 or submit a complete explanation of why you cannot sign (#1B above).

 Pay the correct fee. If reinstating a license after the expiration date, you must pay an additional reinstatement fee.

 Sign your check or money order. DO NOT SEND CASH. (Make checks or money orders payable to “DOPL.”)

 Enclose documentation of your legal name change, if applicable. (See #3 below).

 Mail all fees, forms, and documentation to DOPL at PO Box 146741, Salt Lake City, UT 84114-6741.

LEGAL NAME CHANGE:

If your legal name has changed, you must verify the change by submitting a copy of a

marriage certificate, divorce decree, court order, social security card, or contractor name change form. If your name change

represents a new business entity, you must submit a new application for licensure before beginning practice as the new entity.

ADDRESS CHANGE:

You are responsible to notify DOPL of address changes as they occur. Do not rely on postal

service forwarding orders to provide DOPL with this information. Submit changes online at If licensed as

an entity, including sole proprietor, you must also notify the Utah Division of Corporations of the change: (801) 530-4849.

TIMELY RENEWAL:

You are responsible to comply with all renewal / reinstatement requirements stated in statute and

rule. Your license will automatically expire unless you renew it prior to its expiration date. Therefore, you are encouraged to

immediately submit a completed Application for License Renewal / Reinstatement. You can save time by renewing online at

where you can immediately print out a confirmation of renewal.

APPLICATION APPROVAL:

Your application will be approved unless you do not meet the renewal / reinstatement

requirements or have engaged in serious misconduct. Licenses with specific requirements listed on page 1 of this form may be

subject to audit by DOPL. Those selected for audit will be notified. Please note that DOPL reserves the right to initiate action

at any time against a licensee who did not meet the renewal / reinstatement requirements at the time the license was issued.

NON-REFUNDABLE FEES:

Renewal fees paid with this application are for processing your request for renewal of

licensure and are non-refundable. Please be aware that simply paying the fees does not mean that your license will be

automatically renewed unless you meet the current renewal requirements and thereby qualify for a renewed license.

REINSTATEMENT FEES:

If you fail to timely renew your license, you will be subject to the following conditions:

A) If you are reinstating your license within 30 days after the expiration date of your license, you must submit the

renewal fee PLUS an additional $20.00 for EACH license being reinstated.

B) If you are reinstating your license after 30 days and within two years of the expiration date of your license, you must

submit the renewal fee PLUS an additional $50.00 for EACH license being reinstated. (Reinstating Lien Recovery

Fund members must also submit another $50.00 in addition to any special LRF assessments.)

C) Fees are subject to change each July 1. If listed, the fees on the application are current at the time printed. Please verify the

current fee at

if applying for reinstatement more than one year following expiration of your license.

NOTICE:

If you fail to reinstate your license within two years of the expiration date of your license, you must

submit a new application, meet current requirements for licensure, and pay the fees specified in

subsection R156-1-308g(3). Contact DOPL for assistance if reinstating after two years of expiration.

ON-LINE RENEWAL INFORMATION:

Most professional licenses can be renewed on-line at

by using a credit or debit card and a unique “Renewal ID Number” (similar to a pin number). This timesaving system allows a

renewing licensee to immediately print out a confirmation of renewal that is as valid as a license certificate and can be used

until a renewed license certificate arrives by mail within two weeks. Contact DOPL if you do not have a renewal ID number.

TAX ID NUMBER:

10.

The Tax ID Number for the Division of Occupational and Professional Licensing is 87-6000545.

Application For License Renewal - Salt Lake City Page 2

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