skip to content
Primary navigation

Duplicate License for Lost/Destroyed License or Name Change

Any licensee who loses, destroys or damages their license (or has a name change requiring a new license) may obtain a duplicate license for a fee of $10 and a notarized statement concerning the disposition of their earlier issued license. For a name change, a copy of the legal document (marriage certificate, divorce decree, court order) showing pre and post names is required.  If you have ordered a license certificate or have renewed and your certificate has not arrived, please contact the Board office by email to arrange for a new copy.  

Report a name change by submitting the Name Change Form and fee by mail. 

Order a Duplicate Certificate - Log in to your account and select Online Services from the menu in the upper right of the account screen - the $10 fee can be paid by credit or debit card

Duplicate License for Second Facility (Shared Administrator)

Licensees who serve as administrators for two facilities must obtain a second (duplicate) license from the board so that they can display their license at both facilities that they administer.

A second shared license must be obtained if a licensee becomes AOR of a second facility.  The fee is $225. Please submit the shared administrator form along with a check or money order for the fee to the Board office.

Report a Change of Facility - Log in to your account and navigate to the Administrator of Record section of the Profile tab to add your second site

Fees - State Rules 144A

144A.291   FEES.

back to top