Name / Address Change Form

FFICE OF

CCUPATIONS AND

ROFESSIONS

P.O. Box 1360, Frankfort, Kentucky 40602 ~ 911 Leawood Drive, Frankfort, Kentucky 40601

(502) 564-3296 ~

NAME / ADDRESS CHANGE FORM

PPLICATION INSTRUCTIONS

1. This application must be printed and mailed in with proof of name/address change.

2. Proof for Name Change:

a) Copy of Marriage Certificate

b) Copy of Name Change Order

c) Copy of updated Driver’s License

3. Proof for Address Change:

a) Business letterhead/stationary

b) Piece of mail to individual’s new address (i.e. utility bill, phone bill, library notice, etc…)

c) Copy of updated Driver’s License

4. The completed form and supporting documentation may be submitted and addressed to:

(Enter Board Name Here)

P.O. Box 1360

Frankfort, Kentucky, 40602.

The form may also be hand delivered to the Office of Occupations and Professions, 911

Leawood Drive, Frankfort, Kentucky, 40601.

Revised 12/5/14

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Parent category: Legal