A request for a replacement farm labor contractor license shall be accompanied by a Declaration and Request for Replacement License, signed under penalty of perjury, which shall contain the following information: farm labor contractor license number, name, address and telephone number of the contractor, expiration date, statement of circumstances necessitating replacement, and a $25 license replacement fee. If an applicant provides the information required by this section, a replacement license shall be issued upon request. The replacement shall be issued only to replace a license which is lost, destroyed, or mutilated.