Change of Address, Division of Licensing

Change of Address for Individuals Licensed Under Chapter 493, Florida Statutes

Be sure to enter your license number as it appears on your license.

If the license prefix is one letter (A, B, C, D, E, G, K, M, R), type the letter followed by a space.
For example: The format of a "D" license is "D 1234567".

If the license prefix is two letters (AA, BB, AB, CC, DI, DS, EE, MA, MB, MR, RI, RR, RS), type both letters with NO space.
For example: The format of an "AA" license is "AA1234567".

Individual Information

* Name:

* License Number:

* Date of Birth: (mm/dd/yyyy)	Social Security Number:
/ /	- -

Contact Information

Daytime Phone Number:	Fax Number:
( ) -	( ) -
* Email Address:

* Confirm Email Address:

Do you have other licenses that need to be changed?
Yes No

	Previous Mailing Address		New Mailing Address


City	St	City	St
Zip	-	Zip	-

	Previous Residence Address		New Residence Address


City	St	City	St
Zip	-	Zip	-

MANDATORY DISCLOSURE OF SOCIAL SECURITY NUMBERS

Sections 493.6105, 493.6304, and 493.6406, Florida Statutes (F. S.), in conjunction with section 119.071(5) (a) 2, F. S., mandates that the Department of Agriculture and Consumer Services, Division of Licensing, obtain social security numbers from applicants. Applicant social security numbers are maintained and used by the Division of Licensing for identification purposes, to prevent misidentification, and to facilitate the approval process by the Division. The Department of Agriculture and Consumer Services, Division of Licensing, will not disclose an applicant’s social security number without consent of the applicant to anyone outside of the Department of Agriculture and Consumer Services, Division of Licensing, or as required by law. [See Chapter 119, F. S., 15 U.S.C. ss. 1681 et seq., 15 U.S.C. ss. 6801 et seq., 18 U.S.C. ss. 2721 et seq., Pub. L. No. 107-56 (USA Patriot Act of 2001), and Presidential Executive Order 13224.]