If your license renewal for 2012 is completed after December 31, 2011, you must complete a Delinquent License Renewal Declaration and Acknowledgement (Delinquent Affidavit).  This document must be notarized and submitted to the REAB office.  The final deadline for delinquent renewal is June 30, 2012.  After the deadline, you must apply as an initial applicant, if you wish to continue in the licensed status.   This is a matter of law and cannot be waived by the REAB.

In order to print your Delinquent Affidavit, click here to be directed to the Licensee Search page.  After completing the search for your license record, click on your name. When your license information appears, click on the Print Delinquent Affidavit link.