After you have filled out and printed the previous page, select the professions for which you desire a listing and total the fee(s) at the bottom and print out this page.
Upon completion of printing out both pages, please submit them along with the appropriate fee to the address at the top of the first page.

LICENSED PROFESSIONS & FEE

Select the Type of License(es)
You may check more than one box.

License Count (Approx.)

Cost

Select the Type of License(es)
You may check more than one box.

License Count (Approx.)

Cost

Accountancy - Certified Public Accountants

9982

$23 Physician Assistants 994 $12
Accountancy - Certified Public Accounting Firms 1041 $12 Nursing, Registered Nurses 45511 $30
Acupuncturists 514 $12 Nursing, Certified Nurse Aides 20764 $30
Alcohol Drug Abuse Counselors 2024 $23 Nursing, Licensed Practical Nurses 9708 $23
Architects 6013 $23
Barber/Cosmetology - Cosmetologists 25324 $30 Optometrists 1064 $12
Barber/Cosmetology - Barbers 2494 $23 Outfitters 790 $12
Barber/Cosmetology - Manicurists 6987 $23 Pharmacists 8670 $23
Barber/Cosmetology - Cosmeticians 1737 $12 Prescription Drug Outlets 821 $12
Barber/Cosmetology - Barber/Beauty Shops 5691 $23 Pharmacy Other Outlets 231 $12
Chiropractors 1936 $12 Pharmacy Interns, 50-Year Pharmacists and Limited License Facilities 565 $12
Dentists 3806 $23 Physical Therapists 4606 $23
Dental Hygienists 3322 $23 Plumbers, Journeyman 2305 $23
Electrical Contractors 2808 $23 Plumbers, Master 3183 $23
Electrical Apprentice 14476 $23 Plumbers, Residential 312 $12
Electricians, Journeyman 8558 $23 Plumbers, Apprentice 8935 $23
Electricians, Master 4805 $23 Podiatrists 191 $12
Electricians, Residential 939 $12 Professional Counselors 2467 $23
Engineers and Land Surveyors 20465 $30 Psychologists 1940 $12
Hearing Aid Dealers & Audiologists 282 $12 Unlicensed Psychotherapists 1382 $12
Marriage & Family Therapists 475 $12 Social Workers 2988 $23
Midwives, Direct-Entry 40 $12 Respiratory Therapist 1735 $78
Nursing Home Administrators 592 $12 Veterinarians 3462 $23
Physicians 12855 $30 All Professions in the Department including Real Estate and Insurance 400,000 $78
GRAND TOTAL:

Upon completion of this form - verify your entries, print out this page and submit it along with the previous page
and appropriate fee as totaled above.

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