For State Fire Marshal Use Only Date Fire Marshal License # Issued 2401 NW 23rd, Retest PO # (405) 522-5006 Fax: (405) 522-5028 $50.00 Retesting Application Fee Fire Extinguisher Industry Total Amount Owed: Retesting Application Form Date Paid Amount Paid Please type or print in ink. Submit one form for each test failed Date of Last Exam: Test that was Failed: Employing Company: Last Name: First Name: Middle Initial: Social Security #: Address: City: State: Zip: Home Phone #: Cell Number: Date: Applicant’s Signature: Return To: . Oklahoma State Fire Marshal 2401 NW 23rd, Suite 4 Oklahoma City, Oklahoma 73107
For State Fire Marshal Use Only Fire Marshal 2401 NW 23rd, (405) 522-5006 Fax: (405) 522-5028 Fire Extinguisher Industry Retesting Application Form Retest License # Date Issued PO # Retesting Application Fee $50.00 Total Amount Owed: Date Paid Amount Paid Please type or print in ink. Submit one form for each test failed Date of Last Exam: Test that was Failed: Employing Company: Last Name: First Name: Middle Initial: Social Security #: Address: City: State: Zip: Home Phone #: Cell Number: Applicant’s Signature: Date: Return To: . Oklahoma State Fire Marshal 2401 NW 23rd, Suite 4 Oklahoma City, Oklahoma 73107
Fire%20Ext%20Retest%20Application.docx