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The document is an application form for medical licensing in California, requiring a recent 2" by 2" photo and mandatory information from the applicant. It includes a declaration affirming the truthfulness of the provided information, authorizations for information release to the Medical Board, and a notary section for verification. The document emphasizes that any omissions or misrepresentations can lead to denial or revocation of the license.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (66 Votes)
2019	4.3 Satisfied (34 Votes)

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