Department of Licensing and Consumer Protection

dlcp@dc.gov

1100 4th Street, SW, Washington, DC 20024

(202) 671-4500

Occupational and Professional License Online Cancellation Request Form

You are required to notify the Department of Licensing and Consumer Protection that your licensed business activity has ended. You may use this form to notify the Department and to request that Occupational and Professional cancel your license. Please note that upon submission of your cancellation request, the license will be cancelled and the authority granted therein is no longer valid.

***PLEASE NOTE THAT BY COMPLETING, SUBMITTING AND SIGNING THIS FORM, YOU CONFIRM YOUR AUTHORITY TO AFFECT THE CANCELLATION OF THIS LICENSE.***

Name of Business

Occupational/Professional License Number

Reason for Cancellation

Describe Reason for Cancellation

Requestor's Phone Number

Requestor's Email Address

I certify that the above statements on this application are true and complete to the best knowledge and belief. I agree to comply with all applicable laws and regulations of the District of Columbia. I/We understand that, anyone who makes a false statement on this form can be criminally prosecuted; and, if convicted, fined up to $1000, imprisoned up to 180 days, or both, under D.C. Official Code § 22-2405.

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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.