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Certificate For Cancellation - California

Certificate For Cancellation Form. This is a California form and can be used in Board Of Pharmacy Statewide .
 Fillable pdf Last Modified 7/24/2013
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California State Board of Pharmacy 1625 N. Market Blvd, Suite N219, Sacramento, CA 95834 Phone (916) 574-7900 Fax (916) 574-8618 %86,1(66 &21680(5 6(59,&(6 $1' +286,1* $*(1&< DEPARTMENT OF CONSUMER AFFAIRS *29(5125 ('081' * %52:1 -5 CERTIFICATE FOR CANCELLATION Name of Financial Institution (ISSUER):______________________________ Address:_______________________________________________________ City, State Zip:__________________________________________________ Name of Applicant/Licensee:_______________________________________ Address:_______________________________________________________ City, State Zip:_________________________________________________ IRREVOCABLE STANDBY LETTER OF CREDIT NO. ________________ Beneficiary: California State Board of Pharmacy 1625 N. Market Blvd, Suite N219 Sacramento, CA 95834 The undersigned, a duly Authorized Representative of the California State Board of Pharmacy (Board) (as defined in the above referenced CREDIT), hereby certifies to the ISSUER that: 1. The license for which the credit was issued has expired or otherwise become inoperable, thereby making the cancellation of the credit appropriate. 2. The Board therefore requests the cancellation of the above-referenced CREDIT. THEREFORE, the undersigned has executed and delivered this CANCELLATION as of the ___day of ______, 20__. CALIFORNIA STATE BOARD OF PHARMACY By VIRGINIA K. HEROLD Executive Officer American LegalNet, Inc.
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