Free 50947.FH11 - Indiana

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APPLICATION FOR WAIVER OF AUCTIONEER CONTINUING EDUCATION
State Form 50947 (R2 / 5-08)

Send to: STATE OF INDIANA INDIANA AUCTIONEER COMMISSION PROFESSIONAL LICENSING AGENCY 402 West Washington Street, Room W072 Indianapolis, Indiana 46204 Telephone: (317) 234-3040 E-mail: [email protected] www.pla.IN.gov Pursuant to IC 25-6.1-9-9, an applicant may request a waiver from all or part of the continuing education requirement because the applicant was not able to fulfill the requirement due to a hardship that resulted from any of the following conditions (check one): Service in the armed forces of the United States during a substantial part of the renewal period. An incapacitating illness or injury. Other ** PLEASE PROVIDE EVIDENCE OF SERVICE IN THE ARMED FORCES OR A DOCTORS STATEMENT VERIFYING THE INCAPACITATING ILLNESS OR INJURY.
Name of applicant Address (number and street, city, state, and ZIP code) License number

Signature of applicant

Date (month, day, year)

REASON FOR REQUEST

FOR OFFICE USE ONLY Approved Comments: Tabled Denied

Signature

Date (month, day, year)