172 Neb. Admin. Code, ch. 10, § 006 - VOLUNTARY SURRENDER OR LIMITATION

A credential holder may offer to voluntarily surrender or limit a credential issued by the department. The offer must be in writing and include:

(A) The credential holder's legal name and any other names by which the credential holder is known;

(B) The credential holder's complete mailing address;

(C) The credential holder's telephone number and e-mail address;

(D) The credential(s) and credential number(s) that would be surrendered or limited;

(E) The desired time frame for offered surrender or limitation:

(i) Permanently;

(ii) Indefinitely; or

(iii) Definite period of time (specify);

(F) The specific reason for offered surrender or limitation of the credential;

(G) Any specific terms and conditions that the credential holder wishes to have the department consider and apply to the offer;

(H) An attestation that all the information on the offer is true and complete; and

(I) The credential holder's signature and date.

Notes

172 Neb. Admin. Code, ch. 10, § 006

Adopted effective 6/24/2019