Free 51185.PDF - Indiana

APPLICATION FOR ACTIVATION OF A LAND SURVEYOR CERTIFICATE OF REGISTRATION (State Board of Registration for Land Surveyor)
State Form 51185 (12-02) Approved by State Board of Accounts, 2002

Applicant Instruction:

In order to reactivate an inactive license, a registered land surveyor must: (1) Complete the reactivation form. (2) Submit the appropriate renewal fee. * * For the July 31, 2002 renewal, the registered land surveyor is required to pay one hundred twelve dollars ($112). * For the July 31, 2004 renewal, the registered land surveyor is required to pay one hundred forty eight dollars ($148). (3) Attach copies of your continuing education certificates of completion. ** ** For the July 31, 2002 renewal, the registered land surveyor must complete twenty-one (21) hours of continuing education, including six (6) mandatory hours and fifteen (15) elective hours. ** For the July 31, 2004 renewal, the registered land surveyor must complete twenty-four (24) hours of continuing education, including six (6) mandatory hours and eighteen (18) elective hours. (4) Mail to: INDIANA PROFESSIONAL LICENSING AGENCY 302 West Washington Street, Room E034 Indianapolis, Indiana 46204 317-232-2980

APPLICANT INFORMATION
Name of applicant Certificate number

Residence address (number and street, city, state, ZIP code)

Telephone number ( Signature of applicant ) Date (month, day, year)

A registered land surveyor who has been inactive for a period of six (6) years or less at the date of this application must either: (1) pass part IIB of the next regularly scheduled land surveyors examination; or (2) show proof of having completed twenty-four (24) hours of continuing education, six (6) hours under 865 IAC 1-13-6 and eighteen (18) hours under 865 IAC 1-13-7, within two (2) year period immediately prior to the date the reactivation application is filed. A registered land surveyor who has been inactive for a period of more than six (6) years at the date the reactivation application is filed must: (1) pass part IIB of the next regularly scheduled land surveys examination; and (2) show proof of having complete twenty-four (24) hours of continuing education; six (6) hours under 865 IAC 1-13-6 and eighteen (18) hours under 865 IAC 1-13-7, within the two (2) year period immediately prior to the date the reactivation application is filed.