Free Michigan Mechanic Certification Renewal Form - AR-0094 - Michigan

AR-0094 (02/09) By Authority of Public Act 300 of 1974

DEPARTMENT USE ONLY APPROVED BY DATE

Clear Form

MICHIGAN MECHANIC CERTIFICATION RENEWAL
TO AVOID DELAY IN RECEIVING YOUR NEW MECHANIC CERTIFICATE, PLEASE RETURN THIS RENEWAL IMMEDIATELY. CHANGE OF ADDRESS MUST BE INDICATED IN ITEM 6 BELOW. 1. CERTIFICATION NUMBER 2. COUNTY 3.

BIRTH DATE

4.

EXPIRATION DATE

mm/dd/yy
5. EMAIL ADDRESS

mm/dd/yy

6.

Enter Last Name, First Name, Middle Initial

Enter Street Address

Enter City, State, Zip Code

DEAR MECHANIC:

THIS IS YOUR ONLY RENEWAL NOTICE!

YOUR MICHIGAN MECHANIC CERTIFICATION WILL EXPIRE ON THE DATE SHOWN IN BOX 4. TO RENEW YOUR CERTIFICATION, PLEASE CHECK THE INFORMATION IN BOXES 1 THROUGH 6 FOR ANY ERRORS. FILL IN ANY MISSING INFORMATION OR DRAW A LINE THROUGH ANY ERROR AND PRINT IN THE CORRECT INFORMATION. BEFORE RETURNING THIS FORM, COMPLETE ITEMS 7 THROUGH 10. IF YOU ALLOW YOUR CERTIFICATION TO EXPIRE: You may no longer work as a certified mechanic, and you will be charged a late renewal fee which is one and one half (1 ½) times the regular renewal fee. 7. CERTIFICATION FEE (CHECK THE APPROPRIATE BOX): Regular Renewal Fee - $20.00 (You must pay a late fee if this renewal form is received after the expiration date shown in Box 4.) Late Renewal Fee - $30.00 (This amount is due after the expiration date shown in Box 4.) IF YOUR CERTIFICATION HAS BEEN EXPIRED MORE THAN 12 MONTHS, CALL 1-888-SOS-MICH (1-888-767-6424) FOR INSTRUCTIONS. 8. CONVICTIONS ­ If you have been convicted of an auto-related crime, other than a traffic violation, in Michigan or any other state within the past 12 months, give complete details below. Attach additional sheet, if necessary. Cannot be left blank - if no convictions, enter not applicable (n/a). Details: Date of Conviction(s):

Same as above - cannot be left blank.
Court of Record: City and State:

9. CERTIFICATION AND SIGNATURE. I certify to the truth and accuracy of all statements and representations made in this application, including all statements attached hereto, and further agree that any legal process affecting me served on the Secretary of State or his/her deputies shall have the same effect as if it were personally served on me, and hereby authorize the release of all criminal history information on file at the Michigan State Police Central Records Division that pertains to me. I further certify that I have NOT been convicted of an auto-related crime, other than a traffic violation, within the last 12 months unless indicated above.

Don't forget to sign and date the form before mailing.

Signature

Date

Any misleading, incomplete, or false statement, or failure to notify the Department of State of material changes, may be grounds for revocation, suspension, or denial of certification as a Michigan motor vehicle mechanic. Make check or money order payable to: STATE OF MICHIGAN. DO NOT SEND CASH. Change of address must be indicated in Item 6 above. RETURN TO: Michigan Department of State

Licensing Unit Lansing, Michigan 48918

REMINDER: If you perform motor vehicle repairs part-time or evenings at any place other than a registered repair facility, you must obtain a repair facility registration if you intend to be paid for the work you perform.
DEPARTMENT USE ONLY

Questions regarding Mechanic Certification call 1-888-SOS-MICH (1-888-767-6424) and ask for Licensing Unit.

Motor Vehicle Service and Repair Act training (basic regulatory requirements) is now available to repair facility owners, managers, and other personnel at no charge! To register, call (517) 373-6993.