
Get the free NAME CHANGE Submit a photocopy of a legal document verifying the name change (i
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STATE BOARD OF DENTISTRY
KEEP A COPY OF THIS APPLICATION
FOR YOUR RECORDS.REACTIVATION APPLICATION
Anesthesia Unrestricted Permit DARe turn to:
State Board of Dentistry
PO Box 2649
Harrisburg, PA
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How to fill out name change submit a
01
Fill out the name change submit a form with your current and desired name
02
Provide proof of identification such as a driver's license or passport
03
Submit any required documentation or fees
04
Wait for the name change to be processed and approved
Who needs name change submit a?
01
Individuals who have legally changed their name and need to update official documents
02
Married individuals who want to take their spouse's last name
03
Divorced individuals who want to revert back to their maiden name
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What is name change submit a?
Name change submit a is a form used to officially request a change in legal name.
Who is required to file name change submit a?
Any individual seeking to change their legal name is required to file name change submit a.
How to fill out name change submit a?
Name change submit a can be filled out by providing personal information, reason for name change, and any supporting documentation.
What is the purpose of name change submit a?
The purpose of name change submit a is to request a change in legal name for official purposes.
What information must be reported on name change submit a?
Information such as current legal name, new desired name, reason for name change, and any supporting documentation must be reported on name change submit a.
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