Form DBPR BCAIB6 "Individual Change of Status Transactions" - Florida

What Is Form DBPR BCAIB6?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2019;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DBPR BCAIB6 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR BCAIB6 "Individual Change of Status Transactions" - Florida

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State of Florida
Department of Business and Professional Regulation
Building Code Administrators and Inspectors Board
Individual Change of Status Transactions
Form # DBPR BCAIB 6
TRANSACTION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
form to ensure faster processing.
TRANSACTION
TRANSACTION REQUIREMENTS
Personal Name
Complete Sections I, II and V of this form.
Change
Submit supporting legal documentation of name change (e.g. court
documents showing name change, marriage license, divorce decree,
etc.).
Personal Address
Complete Sections I, III and V of this form.
Change
No Fee.
Set License to
Complete Sections I, IV and V of this form.
Inactive
Pay $5 fee (make check payable to the Department of Business and
Professional Regulation).
Set License to
Complete Sections I, IV and V of this form.
Active
Pay $5 fee (make check payable to the Department of Business and
Professional Regulation).
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, Fl 32399-0783
DBPR BCAIB 6- Individual Change of Status Transactions
Eff. Date August 2019
Incorporated by Rules: 61-35.008
1 of 3
State of Florida
Department of Business and Professional Regulation
Building Code Administrators and Inspectors Board
Individual Change of Status Transactions
Form # DBPR BCAIB 6
TRANSACTION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
form to ensure faster processing.
TRANSACTION
TRANSACTION REQUIREMENTS
Personal Name
Complete Sections I, II and V of this form.
Change
Submit supporting legal documentation of name change (e.g. court
documents showing name change, marriage license, divorce decree,
etc.).
Personal Address
Complete Sections I, III and V of this form.
Change
No Fee.
Set License to
Complete Sections I, IV and V of this form.
Inactive
Pay $5 fee (make check payable to the Department of Business and
Professional Regulation).
Set License to
Complete Sections I, IV and V of this form.
Active
Pay $5 fee (make check payable to the Department of Business and
Professional Regulation).
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, Fl 32399-0783
DBPR BCAIB 6- Individual Change of Status Transactions
Eff. Date August 2019
Incorporated by Rules: 61-35.008
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State of Florida
Department of Business and Professional Regulation
Building Code Administrators and Inspectors Board
Individual Change of Status Transactions
Form # DBPR BCAIB 6
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
For additional information see the Instructions at the beginning of this application.
Section I – Application Type
CHECK ONE OF THE TRANSACTION TYPES
(Use multiple forms if more than one transaction is applicable)
Personal Name Change
Complete Sections I, II and V.
Personal Address Change C
omplete Sections I, III and V.
Set License to Inactive
Complete Sections I, IV and V.
Set License to Active from Inactive
Complete Sections I, IV and V.
LICENSEE INFORMATION
Name:
License Number:
Phone Number:
Email:
Section II – Personal Name Change (provide supporting documentation)
PERSONAL NAME CHANGE INFORMATION
New Name
**NOTE – Your name on your license will appear as it is printed below***
*
Section III – Personal Address Change
NEW MAILING ADDRESS
Street Address
City
State
Zip Code (+4 Optional)
County
Country
DBPR BCAIB 6- Individual Change of Status Transactions
Eff. Date August 2019
Incorporated by Rules: 61-35.008
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Section IV – Set License to Inactive/Active
LICENSEE INFORMATION
Set License to:
 Active
 Inactive
Section V – Affirmation By Written Declaration
AFFIRMATION BY WRITTEN DECLARATION
I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I
understand that my signature on this written declaration has the same legal effect as an oath or
affirmation. Under penalties of perjury, I declare that I have read the foregoing application and the facts
stated in it are true. I understand that falsification of any material information on this application
may result in criminal penalty or administrative action, including a fine, suspension or revocation
of the license.
Signature:
Date:
Print Name:
DBPR BCAIB 6- Individual Change of Status Transactions
Eff. Date August 2019
Incorporated by Rules: 61-35.008
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