Change of Address Form

It is the responsibility of the licensee to report any change of mailing address to the Board within 30 days of the change. Do not use this form to report a name change – please use the Name Change Form. Complete, scan and upload the fillable Change of Address form below:


Change of Address Request Form

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This will be the new address for your license.

This will be the new address for your license.

Scan and upload the completed fillable Change of Address form below:

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