Form DBPR VM9 "Request for Address or Name Change" - Florida

What Is Form DBPR VM9?

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 February 1, 2018;
  • 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 VM9 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

ADVERTISEMENT
ADVERTISEMENT

Download Form DBPR VM9 "Request for Address or Name Change" - Florida

Download PDF

Fill PDF online

Rate (4.5 / 5) 34 votes
1 of 3
State of Florida
Department of Business and Professional Regulation
Board of Veterinary Medicine
Request for Address or Name Change
Form # DBPR VM 9
TRANSACTION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
form to ensure faster processing.
TRANSACTION
TRANSACTION REQUIREMENTS
Personal Name
Complete this entire application.
Change
Submit supporting legal documentation of name change (e.g. court
documents showing name change, marriage license, divorce decree,
etc.).
Personal Address
Complete this entire application.
Change
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0780
DBPR VM 9 Address and Name Change
Eff. Date February 2018
Incorporated by Rule: 61-35.025
1 of 3
State of Florida
Department of Business and Professional Regulation
Board of Veterinary Medicine
Request for Address or Name Change
Form # DBPR VM 9
TRANSACTION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
form to ensure faster processing.
TRANSACTION
TRANSACTION REQUIREMENTS
Personal Name
Complete this entire application.
Change
Submit supporting legal documentation of name change (e.g. court
documents showing name change, marriage license, divorce decree,
etc.).
Personal Address
Complete this entire application.
Change
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0780
DBPR VM 9 Address and Name Change
Eff. Date February 2018
Incorporated by Rule: 61-35.025
2 of 3
State of Florida
Department of Business and Professional Regulation
Board of Veterinary Medicine
Request for Address or Name Change
Form # DBPR VM 9
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 end of this application.
Section I – Application Type
TRANSACTION TYPES
Personal Name Change [9006]
Personal Address Change [9006]
Section II – Licensee Information
LICENSEE INFORMATION
Last/Surname
First
Middle
Suffix
License Number:
NAME AFTER CHANGE
Last/Surname
First
Middle
Suffix
CONTACT INFORMATION
Phone Number
Email Address
MAILING ADDRESS
Street Address
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
Section III – 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 VM 9 Address and Name Change
Eff. Date February 2018
Incorporated by Rule: 61-35.025
3 of 3
Instructions
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.
1. Information
a. You may update both your name and address information at the same time by
selecting both the name and address change transaction.
2. Application Instructions by section
a. Section I – Transaction Type
i.
Name Change
a.
Select this transaction if you need to update your name information.
b.
You must submit supporting legal documentation of the name change (e.g. court
documents showing name change, marriage license, divorce decree, etc.)
c.
You will not receive a new license if you select this transaction.
ii.
Mailing Address Change
a.
Select this transaction if you need to update your mailing address information.
b.
You will not receive a new license showing your updated address information by
selecting this transaction.
b. Section II – Applicant Information
i.
Enter your name exactly as it is shown on your current license.
ii.
Enter your license number.
iii.
Name After Change (complete only if you require update to name information)
a.
If you will be updating your name information, enter your new name as it is shown on
the supporting legal documentation showing the name change.
b.
Applicant must provide supporting legal documentation of name change (e.g. court
documents, marriage license, divorce decree, etc.)
c.
Failure to provide proper legal documents will result in a deficient application.
iv.
Provide a valid phone number and email address. Contact information is often used to
quickly resolve questions with applications by telephone call or email. If contact
information is not provided, questions regarding applications will be mailed to the
applicant’s mailing address and may take longer to resolve.
v.
Provide your mailing address.
c. Section III – Affirmation by Written Declaration
i.
The applicant must sign the affirmation by written declaration.
DBPR VM 9 Address and Name Change
Eff. Date February 2018
Incorporated by Rule: 61-35.025
Page of 3