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A04706 Summary:

BILL NOA04706
 
SAME ASSAME AS S05860
 
SPONSORClark
 
COSPNSRLupardo
 
MLTSPNSR
 
Rpld §6556, amd Ed L, generally
 
Expands the scope of chiropractic practice; authorizes chiropractic clinical assistants.
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A04706 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          4706
 
                               2025-2026 Regular Sessions
 
                   IN ASSEMBLY
 
                                    February 4, 2025
                                       ___________
 
        Introduced  by  M. of A. CLARK, LUPARDO -- read once and referred to the
          Committee on Higher Education
 
        AN ACT to amend the  education  law,  in  relation  to  modernizing  the
          chiropractic  scope  of  practice; and to repeal certain provisions of
          such law relating thereto

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1. Section 6551 of the education law, as added by chapter 987
     2  of the laws of 1971, paragraphs a and b of subdivision 2 as  amended  by
     3  chapter 450 of the laws of 1983, and subdivision 3 as amended by chapter
     4  683 of the laws of 1991, is amended to read as follows:
     5    § 6551. Definition  of  practice of chiropractic.   1. The practice of
     6  the profession of chiropractic is defined as [detecting  and  correcting
     7  by  manual  or  mechanical  means  structural  imbalance, distortion, or
     8  subluxations in the human body for the purpose of removing nerve  inter-
     9  ference  and  the effects thereof, where such interference is the result
    10  of or related to distortion, misalignment or subluxation of  or  in  the
    11  vertebral  column. 2.] the examination, evaluation, detection, diagnosis
    12  of the human body and/or treatment or correction of: subluxations in the
    13  vertebral column or other articular segments  by  manual  or  mechanical
    14  means,    neuromusculoskeletal    conditions,    structural   imbalance,
    15  distortion, and/or dysfunction of the human body and the effects  there-
    16  of;  including  restoring  nervous  system integrity, structural balance
    17  and/or function; as it may relate to any human  disease,  pain,  injury,
    18  deformity or physical condition.
    19    2.  a.  The  practice of chiropractic includes, but is not limited to,
    20  physical and functional examination of patients, health assessment, work
    21  capability assessment, handicap eligibility assessment, school and other
    22  sports assessment, school attendance assessment, spinal  health  assess-
    23  ment,  analysis,  or  to  give consultation, advice, recommendations and
    24  counseling regarding  anatomy,  physiology,  neurology,  general  health
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05767-01-5

        A. 4706                             2
 
     1  matters, wellness and health optimization by any means of communication,
     2  the  use of x-ray and diagnostic imaging studies using ionizing and non-
     3  ionizing imaging methods, adjustment, mobilization, manipulation,  trac-
     4  tion,  and  decompression,  and  other  procedures consisting of but not
     5  limited to, heat, cold, light, air, water, sound, electricity,  massage,
     6  manual therapies, therapeutic exercise with or without assistive devices
     7  and  clinical  laboratory  testing methods approved by the department as
     8  being appropriate to the practice of chiropractic.
     9    b. Chiropractic examination, diagnostic and treatment methods may also
    10  include electrodiagnostic testing and manipulation under anesthesia when
    11  appropriate education standards have been met and  as  approved  by  the
    12  department as being appropriate to the practice of chiropractic.
    13    c.  The  practice  of the profession of chiropractic allows a licensed
    14  chiropractor who has successfully completed a registered doctoral, post-
    15  doctoral or continuing  education  certification  program  of  a  higher
    16  education credential by an accrediting agency, which contains courses of
    17  study  in wellness care methods, nutrition, and dietary advice satisfac-
    18  tory to the department; use of wellness care methods and the ability  to
    19  engage  in  nutritional  counseling  and  dietary  advice, including the
    20  dispensing of food concentrates, food  extracts,  nutraceuticals,  vita-
    21  mins,  minerals,  and  other  nutritional  supplements  approved  by the
    22  department as being appropriate to, and as a part of,  the  practice  of
    23  chiropractic,  as the above relates to the definition of the practice of
    24  chiropractic in subdivision one of this section.
    25    3. a.  A license to practice as a chiropractor shall permit a  chirop-
    26  ractic  practitioner  in  their  professional  discretion the ability to
    27  take, order and use x-ray and diagnostic imaging studies but  shall  not
    28  permit  the  holder  thereof  to use [radio-therapy, fluoroscopy, or any
    29  form of ionizing radiation except X-ray which  shall  be  used  for  the
    30  detection  of  structural  imbalance, distortion, or subluxations in the
    31  human body] ionizing radiation sources for the purposes of radiotherapy.
    32    b. The requirements and limitations with respect to the use of [X-ray]
    33  diagnostic imaging studies by chiropractors shall  be  enforced  by  the
    34  state  commissioner of health and [he] the commissioner is authorized to
    35  promulgate rules and  regulations  after  conferring  with  the  [board]
    36  department to carry out the purposes of this subdivision.
    37    c.  Chiropractors  shall retain for a period of three years all [X-ray
    38  films] diagnostic images taken in the course of their practice, together
    39  with the records pertaining thereto, and shall make such [films]  images
    40  and records available to the state commissioner of health or [his] their
    41  representative on demand.
    42    [3.]  4.  Chiropractors may use diagnostic clinical laboratory methods
    43  involving chemical  or  biological  means  which  particular  tests  and
    44  services shall be approved by the department as appropriate to the prac-
    45  tice of chiropractic.
    46    5.  A  license  to  practice  chiropractic shall not permit the holder
    47  thereof to treat for any infectious  diseases  such  as  pneumonia,  any
    48  communicable  diseases  listed  in the sanitary code of the state of New
    49  York, any of the cardio-vascular-renal or cardio-pulmonary diseases, any
    50  surgical condition [of  the  abdomen  such  as  acute  appendicitis,  or
    51  diabetes],  or  any benign or malignant neoplasms; to operate; to reduce
    52  fractures [or dislocations]; to prescribe, administer, dispense  or  use
    53  in  [his]  their  practice  drugs or medicines[; or to use diagnostic or
    54  therapeutic methods involving chemical or biological means except  diag-
    55  nostic  services performed by clinical laboratories which services shall
    56  be approved by the board as appropriate to the practice of chiropractic;

        A. 4706                             3

     1  or to utilize electrical devices except those devices  approved  by  the
     2  board  as  being  appropriate  to  the practice of chiropractic. Nothing
     3  herein shall be construed to prohibit a licensed  chiropractor  who  has
     4  successfully  completed  a  registered doctoral program in chiropractic,
     5  which contains courses of study in nutrition satisfactory to the depart-
     6  ment, from using nutritional counseling,  including  the  dispensing  of
     7  food  concentrates,  food extracts, vitamins, minerals, and other nutri-
     8  tional supplements approved by the board as being appropriate to, and as
     9  a part of, his or her practice of chiropractic. Nothing herein shall  be
    10  construed  to prohibit an individual who is not subject to regulation in
    11  this state as a licensed chiropractor from engaging in nutritional coun-
    12  seling.] or controlled substances or to administer or  use  anesthetics.
    13  Chiropractors may use topical analgesic substances and anesthetic balms,
    14  salves or emollients or advise on over the counter substances.
    15    § 2. Section 6552 of the education law, as added by chapter 987 of the
    16  laws of 1971, is amended to read as follows:
    17    § 6552. Practice  of  chiropractic  and  use  of title "chiropractor",
    18  "doctor of chiropractic" or "chiropractic physician".    Only  a  person
    19  licensed  [or exempt] or otherwise authorized under this article [shall]
    20  to practice chiropractic [or] may use the title "chiropractor",  "doctor
    21  of chiropractic" or "chiropractic physician".
    22    § 3. Section 6553 of the education law, as added by chapter 987 of the
    23  laws of 1971, is amended to read as follows:
    24    § 6553. State  board for chiropractic.  A state board for chiropractic
    25  shall be appointed by the board of  regents  on  recommendation  of  the
    26  commissioner  for  the purpose of assisting the board of regents and the
    27  department on matters of professional licensing and professional conduct
    28  in accordance with section sixty-five hundred eight of this title.   The
    29  board  shall be composed of not less than [seven] eight members, includ-
    30  ing [at least four] seven licensed chiropractors[, one  licensed  physi-
    31  cian who is a doctor of medicine, one licensed physician who is a doctor
    32  of  osteopathy,  and  one  educator  who holds a doctorate or equivalent
    33  degree in either anatomy, physiology, pathology, chemistry or microbiol-
    34  ogy] in this state for at least five years and one public  member.    An
    35  executive  secretary  to  the  board  shall be appointed by the board of
    36  regents on recommendation of the commissioner.
    37    § 4. Section 6554 of the education law, as added by chapter 987 of the
    38  laws of 1971, subdivision 3 as amended by chapter 994  of  the  laws  of
    39  1971,  subdivision  6 as amended by chapter 669 of the laws of 2022, and
    40  subdivision 8 as amended by chapter 62 of the laws of 1989,  is  amended
    41  to read as follows:
    42    § 6554. Requirements  for  a  professional  license.  To qualify for a
    43  license as a chiropractor, an  applicant  shall  fulfill  the  following
    44  requirements:
    45    (1) Application: file an application with the department;
    46    (2) Education: have received an education, including [two] three years
    47  or  ninety  semester  hours of credit or equivalent trimester or quarter
    48  hours of credit of preprofessional college study  and  completion  of  a
    49  [four-year  resident  program  in chiropractic,] program of chiropractic
    50  education of not less than four academic years, or the equivalent there-
    51  of in accordance with the commissioner's regulations;
    52    (3) Experience: have experience  satisfactory  to  the  board  and  in
    53  accordance with the commissioner's regulations[:];
    54    (4)  Examination:  pass  examinations satisfactory to the board and in
    55  accordance with the commissioner's regulations[, in clinical  chiroprac-
    56  tic  analysis,  the  practice  of  chiropractic,  X-ray as it relates to

        A. 4706                             4

     1  chiropractic analysis, and examinations satisfactory to  the  department
     2  in  anatomy,  physiology, pathology, chemistry, microbiology, diagnosis,
     3  and the use and effect of X-ray] for the practice of chiropractic;
     4    (5) Age: be at least twenty-one years of age;
     5    (6) Citizenship or immigration status: be a United States citizen or a
     6  noncitizen  lawfully  admitted  for  permanent  residence  in the United
     7  States;
     8    (7) Character: be of good moral character as determined by the depart-
     9  ment; and
    10    (8) Fees: pay a fee of one hundred seventy-five dollars to the depart-
    11  ment for [admission to a department conducted examination  and  for]  an
    12  initial  license  upon  completion  and passage of a department approved
    13  examination, a fee of eighty-five dollars for each reexamination, a  fee
    14  of  one  hundred  fifteen dollars for an initial license for persons not
    15  requiring admission to a department conducted examination, and a fee  of
    16  one hundred fifty-five dollars for each triennial registration period.
    17    §  5.  Section 6555 of the education law, as amended by chapter 537 of
    18  the laws of 1983, is amended to read as follows:
    19    § 6555. Exempt persons.  [Nothing in this article shall  be  construed
    20  to  affect or prevent a student enrolled in a college of chiropractic in
    21  this state from engaging in all phases of clinical practice under super-
    22  vision of a licensed chiropractor or physician in  a  curriculum  regis-
    23  tered  by  the  department.]  The  following persons under the following
    24  limitations  may  practice  chiropractic  within  the  state  without  a
    25  license:
    26    1. A student enrolled in any accredited college of chiropractic engag-
    27  ing  in  all phases of clinical practice under supervision of a licensed
    28  chiropractor or physician in a curriculum registered by the  department;
    29  or
    30    2.  A student who is performing a clinical externship or preceptorship
    31  in a chiropractic office or clinic setting and  who  is  enrolled  in  a
    32  chiropractic  school  which  meets  the  standards  satisfactory  to the
    33  department, provided such practice is under the direct supervision of  a
    34  licensed chiropractor for a maximum period of twelve months; or
    35    3.  Any chiropractor authorized to practice chiropractic while travel-
    36  ling from another  state  or  country  in  which  such  chiropractor  is
    37  licensed, to provide chiropractic services during any emergency services
    38  associated  with  any  rescue,  recovery  or  humanitarian relief effort
    39  provided such practice is limited to the organized  emergency  services;
    40  or
    41    4.  A  chiropractor who is not a resident of this state who is legally
    42  qualified to practice in their state and who is travelling from  another
    43  state  for the purpose of providing chiropractic services for a specific
    44  purpose or event of limited duration; or
    45    5. Any chiropractor who is licensed in another state  or  country  and
    46  who  is  meeting  or  communicating with a chiropractor licensed in this
    47  state, for purposes of consultation, provided such practice  is  limited
    48  to such consultation; or
    49    6.  Any  chiropractor who is licensed in another state or country, who
    50  is visiting a chiropractic school or teaching facility in this state  to
    51  receive  chiropractic  instruction for a period not to exceed six months
    52  or to conduct chiropractic instruction, provided such practice is limit-
    53  ed to such instruction  and  is  under  the  general  supervision  of  a
    54  licensed chiropractor; or

        A. 4706                             5
 
     1    7. Any chiropractor who is authorized by a foreign government to prac-
     2  tice  in  relation  to  its  diplomatic,  consular  or  maritime staffs,
     3  provided such practice is limited to such staffs; or
     4    8.  Any commissioned chiropractic officer who is serving in the United
     5  States armed forces or public health service or any chiropractor who  is
     6  employed  in  the  United  States Veterans Administration, provided such
     7  practice is limited to such service or employment.
     8    § 6. Section 6556 of the education law is REPEALED and a  new  section
     9  6556 is added to read as follows:
    10    § 6556. Limited  permits.  Permits limited as to eligibility, practice
    11  and duration, shall be issued by the department to eligible  applicants,
    12  as follows:
    13    1.  Eligibility: The following persons shall be eligible for a limited
    14  permit:
    15    a. A person who fulfills all requirements for a license  as  a  chiro-
    16  practor  except  those  relating  to  the examination and citizenship or
    17  permanent residence in the United States;
    18    b. A licensed foreign chiropractor who meets guidelines  developed  in
    19  accordance with the commissioner's regulations;
    20    c.  A licensed foreign chiropractor or a foreign intern who is in this
    21  country on a non-immigration visa for the continuation  of  chiropractic
    22  study  who meets guidelines developed in accordance with the commission-
    23  er's regulations;
    24    d. Any graduate of a chiropractic school which meets standards  satis-
    25  factory  to  the department, provided such practice is under the general
    26  supervision of a licensed chiropractor for a maximum  period  of  twelve
    27  months from date of graduation.
    28    2.  Limit  of  practice.  A  permittee shall be authorized to practice
    29  chiropractic only under the supervision of a licensed  chiropractor  and
    30  only in a licensed chiropractic office or clinical setting.
    31    3.  Duration. A limited permit shall be valid for one year.  A limited
    32  permit may be renewed annually at the discretion of the department.
    33    4. Fees. The fee for each limited permit and for each renewal shall be
    34  one hundred five dollars.
    35    § 7. The education law is amended by adding a new section 6557 to read
    36  as follows:
    37    § 6557. Special provisions. 1. Non-liability of licensed chiropractors
    38  for first aid or emergency treatment.  Notwithstanding any  inconsistent
    39  provision  of any general, special or local law, any licensed chiroprac-
    40  tor who voluntarily and without the expectation of monetary compensation
    41  renders first aid or emergency treatment at the scene of an accident  or
    42  other  emergency, outside a hospital, doctor's office or any other place
    43  having proper and necessary chiropractic equipment, to a person  who  is
    44  unconscious,  ill  or injured, shall not be liable for damages for inju-
    45  ries alleged to have been sustained by such person or  for  damages  for
    46  the death of such person alleged to have occurred by reason of an act or
    47  omission  in  the  rendering  of  such  first aid or emergency treatment
    48  unless it is established that such  injuries  were  or  such  death  was
    49  caused  by gross negligence on the part of such chiropractor. Nothing in
    50  this section shall be deemed or construed to relieve a  licensed  chiro-
    51  practor  from  liability  for damages for injuries or death caused by an
    52  act or omission on the part of a chiropractor  while  rendering  profes-
    53  sional services in the normal and ordinary course of their practice.
    54    2.  This  article  shall  not  be  construed  to affect or prevent the
    55  following:
    56    a. The furnishing of any assistance in an emergency;

        A. 4706                             6
 
     1    b. The chiropractor from being a primary portal  of  entry  healthcare
     2  provider.
     3    3.  There  shall be no monetary liability on the part of, and no cause
     4  of action for damages shall  arise  against,  any  person,  partnership,
     5  corporation,  firm,  society, or other entity on account of the communi-
     6  cation of information in the possession of such person or entity, or  on
     7  account  of  any  recommendation or evaluation, regarding the qualifica-
     8  tions, fitness, or professional conduct or practices of a  chiropractor,
     9  to  any governmental agency, chiropractic society, a hospital as defined
    10  in article twenty-eight of the public health law, a hospital as  defined
    11  in  subdivision  ten  of  section  1.03  of the mental hygiene law, or a
    12  health maintenance organization organized under  article  forty-four  of
    13  the  public  health  law  or  article  forty-three of the insurance law,
    14  including a committee of an individual practice association  or  medical
    15  group  acting pursuant to a contract with a health maintenance organiza-
    16  tion. The foregoing shall not apply to information which is  untrue  and
    17  communicated with malicious intent.
    18    § 8. The education law is amended by adding a new section 6558 to read
    19  as follows:
    20    § 6558. Definition  of  chiropractic clinical assistant.  1. A chirop-
    21  ractic clinical assistant is defined as a person certified in accordance
    22  with this article who works under the supervision of a  licensed  chiro-
    23  practor  performing such patient duties as are assigned by the supervis-
    24  ing chiropractor. A chiropractic clinical  assistant  may  only  provide
    25  patient  services on the orders and instructions of a supervising chiro-
    26  practor. Supervision of a chiropractic clinical assistant by a  licensed
    27  chiropractor  shall  be  on-site supervision, but not necessarily direct
    28  personal supervision. The number  of  chiropractic  clinical  assistants
    29  supervised  by  one  licensed chiropractor shall not exceed the ratio of
    30  four chiropractic clinical assistants to one  licensed  chiropractor  as
    31  shall  be  determined  by  the  commissioner's regulations ensuring that
    32  there be adequate supervision in the best interest of public health  and
    33  safety.  Nothing  in  this  section  shall  prohibit a hospital or other
    34  public health law article twenty-eight facility from  employing  chirop-
    35  ractic  clinical assistants, provided they work under the supervision of
    36  a chiropractor, physician, nurse practitioner or other medical  provider
    37  designated  by  the  hospital  or public health law article twenty-eight
    38  facility and not beyond the scope of practice of a chiropractic clinical
    39  assistant.
    40    2. A certified chiropractic clinical assistant may only provide  clin-
    41  ical services on the orders and instructions of a supervising chiroprac-
    42  tor.
    43    3. The scope of services for a certified chiropractic clinical assist-
    44  ant  shall include assisting a chiropractor with providing certain clin-
    45  ical procedures common and customary to the chiropractic  setting  which
    46  include,  but  are  not  limited  to,  the following: collecting general
    47  health data, such as the taking of  an  oral  history,  vital  signs  or
    48  neurological,   physiological  or  anatomical  measurements;  performing
    49  objective data collection tests common and customary to the chiropractic
    50  setting including, but not limited to dynamic  or  static  surface  EMG,
    51  thermography,  heart  rate  variability;  applying  thermal, light, air,
    52  water, sound,  electrical  and  mechanical  modalities;  and  monitoring
    53  prescribed rehabilitative activities.
    54    4.  A  certified  chiropractic  clinical  assistant must be adequately
    55  trained in the proper operation of any device  or  equipment  and  know-
    56  ledgeable of anatomy and the appropriate safety procedures and contrain-

        A. 4706                             7
 
     1  dications  with  respect  to  the clinical services they are directed to
     2  provide.
     3    5.  Nothing  in  this  section shall be construed to allow a certified
     4  chiropractic clinical assistant to provide  a  chiropractic  adjustment;
     5  manipulation;  joint  mobilization; perform radiological tests (X-rays);
     6  nutritional instruction; and counseling or other therapeutic service  or
     7  procedure which requires individual licensure in New York state.
     8    6.  Registration as a certified chiropractic clinical assistant is not
     9  required for individuals who  perform  administrative  activities  of  a
    10  non-clinical nature.
    11    § 9. The education law is amended by adding a new section 6559 to read
    12  as follows:
    13    § 6559. Duties of chiropractic clinical assistant and the use of title
    14  "chiropractic  clinical assistant". Only a person certified or otherwise
    15  authorized under this article  shall  participate  in  the  practice  of
    16  chiropractic  as  a  chiropractic  clinical  assistant and only a person
    17  certified under this section shall use the title "chiropractic  clinical
    18  assistant".
    19    §  10.  The  education  law is amended by adding a new section 6560 to
    20  read as follows:
    21    § 6560. Requirements for  certification  as  a  chiropractic  clinical
    22  assistant.
    23    1. Application: file an application with the department;
    24    2.  Education: have received an education and training in a chiroprac-
    25  tic clinical assistant program in  accordance  with  the  commissioner's
    26  regulations  and department of education; including but not limited to a
    27  minimum of twenty-four hours of didactic study;
    28    3. Experience: have experience  satisfactory  to  the  department  for
    29  chiropractic in accordance with the commissioner's regulations;
    30    4. Examination: pass an examination satisfactory to the department and
    31  in accordance with the commissioner's regulations;
    32    5. Age: be at least eighteen years of age;
    33    6.  Character: be of good moral character as determined by the depart-
    34  ment;
    35    7. Registration: all certified chiropractic clinical assistants  shall
    36  register  triennially  with  the education department in accordance with
    37  the regulations of the commissioner;
    38    8. Fees: pay a fee for an initial certificate of fifty dollars, and  a
    39  fee of fifty dollars for each subsequent triennial registration period.
    40    9.  A  certified  chiropractic  clinical assistant shall conduct them-
    41  selves within the boundaries of proper ethical behavior and shall adhere
    42  to acceptable standards of conduct regardless of whether  a  supervising
    43  chiropractor  or  person in a position of authority may order, impart or
    44  condone behavior or conduct which is improper.
    45    10. "Improper conduct", under  the  meaning  of  this  section,  shall
    46  include  conduct  delineated  under the chiropractic practice act, regu-
    47  lations, and such other New York state laws that may apply.
    48    11. The department may refuse  to  issue,  refuse  to  renew,  or  may
    49  suspend, revoke, censure, reprimand, restrict, or limit the registration
    50  of,  or  fine  any  person pursuant to the laws of New York state or the
    51  procedures set forth herein, upon one or more of the grounds for  disci-
    52  pline set forth in this article.
    53    §  11.  The  education  law is amended by adding a new section 6561 to
    54  read as follows:
    55    § 6561. Exemptions. 1. This article shall not be construed  to  affect
    56  or  prevent  a  chiropractic clinical assistant student from engaging in

        A. 4706                             8
 
     1  clinical assisting under the supervision of a licensed  chiropractor  as
     2  part  of  a  program  conducted  in an approved program for chiropractic
     3  clinical assistants or in a clinical  facility  or  health  care  agency
     4  affiliated with the program for chiropractic clinical assistants.
     5    2.  Supervision  of  a  chiropractic  clinical  assistant student by a
     6  licensed chiropractor shall be on-site  supervision  and  direct  super-
     7  vision.
     8    §  12.  The  education  law is amended by adding a new section 6562 to
     9  read as follows:
    10    § 6562. Limited permits. 1.  The  department  shall  issue  a  limited
    11  permit  to  an applicant who meets all requirements for admission to the
    12  certification examination.
    13    2. All practice under a limited permit shall be under the  supervision
    14  of  a  licensed  chiropractor  or  other  licensed medical provider in a
    15  public hospital, an incorporated hospital or clinic, a licensed proprie-
    16  tary hospital, a licensed nursing home, a public health agency, a recog-
    17  nized public or non-public school setting,  the  office  of  a  licensed
    18  chiropractor, or in the civil service of the state or political subdivi-
    19  sion thereof.
    20    3.  Limited permits shall be for six months and the department may for
    21  justifiable cause renew a limited  permit  provided  that  no  applicant
    22  shall  practice  under  any  limited permit for more than a total of one
    23  year.
    24    4. Supervision of a permittee by  a  licensed  chiropractor  shall  be
    25  on-site supervision and not necessarily direct personal supervision.
    26    5. The fee for each limited permit and for each renewal shall be fifty
    27  dollars.
    28    § 13. This act shall take effect on the first of January next succeed-
    29  ing the date on which it shall have become a law.
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