Form SPS13-12 "Change of Address Form" - Georgia (United States)

What Is Form SPS13-12?

This is a legal form that was released by the Georgia Department of Agriculture - a government authority operating within Georgia (United States). As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 2, 2014;
  • The latest edition provided by the Georgia Department of Agriculture;
  • 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 SPS13-12 by clicking the link below or browse more documents and templates provided by the Georgia Department of Agriculture.

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Download Form SPS13-12 "Change of Address Form" - Georgia (United States)

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Structural Pest Section
19 Martin Luther King, Jr. Dr.
Atlanta, Georgia 30334-4201
Phone: (404) 656-3641
_________________
Date
CHANGE OF ADDRESS FORM
This will affect the following (please check where applicable)
Certification
_____________________(enter number)
Name
____________________________________________
Company License ____________________ (enter number)
Name
___________________________________________
Mailing address
Physical address
The effective date for this change is ___________________________
THE NEW ADDRESS IS:
CITY
STATE
ZIP CODE
New Phone Number (if applicable)
(
) ____________________
New Fax Number (if applicable)
(
) _____________________
E-mail address:__________________________________________
Signed by/Submitted by:_______________________________________________
Submit this form by mail, fax or e-mail (
pest@agr.georgia.gov
)
SPS 13-12 Revised 9/2/14
Structural Pest Section
19 Martin Luther King, Jr. Dr.
Atlanta, Georgia 30334-4201
Phone: (404) 656-3641
_________________
Date
CHANGE OF ADDRESS FORM
This will affect the following (please check where applicable)
Certification
_____________________(enter number)
Name
____________________________________________
Company License ____________________ (enter number)
Name
___________________________________________
Mailing address
Physical address
The effective date for this change is ___________________________
THE NEW ADDRESS IS:
CITY
STATE
ZIP CODE
New Phone Number (if applicable)
(
) ____________________
New Fax Number (if applicable)
(
) _____________________
E-mail address:__________________________________________
Signed by/Submitted by:_______________________________________________
Submit this form by mail, fax or e-mail (
pest@agr.georgia.gov
)
SPS 13-12 Revised 9/2/14