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Licensure Section Credit Card Payment Authorization Licensure Applicant Informat

This 3digit code is your Card Security Code I authorize the Licensure Sectio n of the NC Department of Pu blic Instruction to charge the processing fee for licensing 30 55 85 other amount to my credit card Signature Date Licensure Section 6365

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Licensure Section Credit Card Payment Authorization Licensure Applicant Informat






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