"Address Change Request Form" - Kentucky

Address Change Request Form is a legal document that was released by the Kentucky Labor Cabinet - a government authority operating within Kentucky.

Form Details:

  • The latest edition currently provided by the Kentucky Labor Cabinet;
  • Ready to use and print;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Kentucky Labor Cabinet.

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Download "Address Change Request Form" - Kentucky

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KENTUCKY LABOR CABINET
Division of Workers Compensation Funds
Steven L. Beshear
Larry L. Roberts
Payment Branch
Governor
Secretary
Suite 4, 1047 U.S. Highway 127 South
Frankfort KY 40601
Robert L. Whittaker
www.labor.ky.gov
Director
Telephone: (502) 564-5467
FAX: (502) 564-5112
SFAC
ADDRESS CHANGE REQUEST FORM
Please fill out all information completely.
Sign, date and mail form to:
Kentucky Labor Cabinet
Division of Worker’s Compensation Funds
1047 US HWY 127 South - Ste. 4
Frankfort, KY 40601
Please allow up to 4 weeks for the address change to take effect.
CLAIM NUMBER:
CLAIMANT’S NAME:
SSN#
ADDRESS:
TELEPHONE:
SIGNATURE OF PAYEE
DATE
An Equal Opportunity Employer M/F/D
KENTUCKY LABOR CABINET
Division of Workers Compensation Funds
Steven L. Beshear
Larry L. Roberts
Payment Branch
Governor
Secretary
Suite 4, 1047 U.S. Highway 127 South
Frankfort KY 40601
Robert L. Whittaker
www.labor.ky.gov
Director
Telephone: (502) 564-5467
FAX: (502) 564-5112
SFAC
ADDRESS CHANGE REQUEST FORM
Please fill out all information completely.
Sign, date and mail form to:
Kentucky Labor Cabinet
Division of Worker’s Compensation Funds
1047 US HWY 127 South - Ste. 4
Frankfort, KY 40601
Please allow up to 4 weeks for the address change to take effect.
CLAIM NUMBER:
CLAIMANT’S NAME:
SSN#
ADDRESS:
TELEPHONE:
SIGNATURE OF PAYEE
DATE
An Equal Opportunity Employer M/F/D