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NAME CHANGE FORM Please complete the required information and return this form via mail or email listed below. (please print) Owner Number: ___ Old Owner Name: ___ New Owner Name:___ Social Security
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How to fill out change licensure application packet

01
Obtain the change licensure application packet from the relevant licensing authority.
02
Carefully read all instructions provided in the application packet.
03
Fill out the application form accurately and completely, making sure to provide all required information.
04
Gather any supporting documents or materials required to be submitted along with the application form.
05
Double-check the completed application form and attached documents for accuracy and completeness.
06
Submit the filled out application packet and any required fees to the licensing authority as per their instructions.
07
Follow up with the licensing authority if necessary to ensure that your application is being processed.

Who needs change licensure application packet?

01
Individuals who wish to change or update their licensure credentials or information.
02
Professionals seeking to make modifications to their existing professional licenses.
03
Individuals who have undergone changes in their professional status that require updates to their licensure information.
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The change licensure application packet is a set of documents that entities must submit to request modifications to their existing licensure status, including changes in ownership, address, or service scope.
Entities or individuals who hold a license and wish to make any changes to their licensure status are required to file a change licensure application packet.
To fill out the change licensure application packet, applicants should complete all required forms accurately, provide necessary documentation, and submit the packet to the appropriate licensing authority, following the specific guidelines they provide.
The purpose of the change licensure application packet is to ensure compliance with regulatory requirements when there are changes to a licensee's status or operations, facilitating proper oversight by authorities.
The information that must be reported includes the details of the change being requested, current licensure information, identification of responsible parties, and any pertinent financial or operational data.
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