Form DFS-N1-1705 "Change of Mailing Address or Contact Data - Entities" - Florida

What Is Form DFS-N1-1705?

This is a legal form that was released by the Florida Department of Financial Services - 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 December 1, 2012;
  • The latest edition provided by the Florida Department of Financial Services;
  • 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 DFS-N1-1705 by clicking the link below or browse more documents and templates provided by the Florida Department of Financial Services.

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Download Form DFS-N1-1705 "Change of Mailing Address or Contact Data - Entities" - Florida

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DEPARTMENT OF FINANCIAL SERVICES
Division of Funeral, Cemetery & Consumer Services
200 East Gaines Street
Tallahassee, FL 32399- 0361
Change of Mailing Address or Contact Data -- Entities
Entities (corporations, LLCs, partnerships) use this form to notify the Division of Funeral, Cemetery &
Consumer Services of changes in their address or other contact data. There is no fee. Mail this form to the
Division at the address indicated in the letterhead.
Section 1. Identifying Information
Please provide all data requested in this Section, so that we can accurately identify the record to be updated.
Entity name as licensed:
FEIN:
Existing licensees only -- if you are an existing licensee, enter your license number in this block:
Establishment License Number:
License applicants only -- if you are an applicant for license, indicate what month and year you submitted
your application and what type of license was applied for:
Month
Year
Type of License
Section 2. New Mailing Address and/or Other Contact Data
You may leave blank any data field where no updating is needed. However, if you are in doubt as to what
data the Division has concerning you, feel free to enter data in all data fields below.
Note: A change of actual physical location of a licensed funeral establishment, cinerator facility, direct
disposal establishment, refrigeration facility, removal facility or centralized embalming facility requires Board
approval and/or notification, and this form may not be used to apply for Board approval (please contact Division
Staff to determine which form(s) is needed).
Preferred Mailing Address:
Street:
City:
State:
Zip:
County:
Phone number:
Email address (e.g., smithj@xyz.com):
Area code:
Phone #
-
Section 3. Signature
I, the licensee or applicant identified above, hereby request the Division of Funeral, Cemetery & Consumer
Services to conform the data in their records concerning the funeral director/direct disposer to the information
entered above.
___________________________________
________________________
Signature
Date signed
Form DFS-N1-1705; Change of Mailing Address or Contact Data-Entities
1 of 1
(Rev. 12/12); 69K-1.001
Page
DEPARTMENT OF FINANCIAL SERVICES
Division of Funeral, Cemetery & Consumer Services
200 East Gaines Street
Tallahassee, FL 32399- 0361
Change of Mailing Address or Contact Data -- Entities
Entities (corporations, LLCs, partnerships) use this form to notify the Division of Funeral, Cemetery &
Consumer Services of changes in their address or other contact data. There is no fee. Mail this form to the
Division at the address indicated in the letterhead.
Section 1. Identifying Information
Please provide all data requested in this Section, so that we can accurately identify the record to be updated.
Entity name as licensed:
FEIN:
Existing licensees only -- if you are an existing licensee, enter your license number in this block:
Establishment License Number:
License applicants only -- if you are an applicant for license, indicate what month and year you submitted
your application and what type of license was applied for:
Month
Year
Type of License
Section 2. New Mailing Address and/or Other Contact Data
You may leave blank any data field where no updating is needed. However, if you are in doubt as to what
data the Division has concerning you, feel free to enter data in all data fields below.
Note: A change of actual physical location of a licensed funeral establishment, cinerator facility, direct
disposal establishment, refrigeration facility, removal facility or centralized embalming facility requires Board
approval and/or notification, and this form may not be used to apply for Board approval (please contact Division
Staff to determine which form(s) is needed).
Preferred Mailing Address:
Street:
City:
State:
Zip:
County:
Phone number:
Email address (e.g., smithj@xyz.com):
Area code:
Phone #
-
Section 3. Signature
I, the licensee or applicant identified above, hereby request the Division of Funeral, Cemetery & Consumer
Services to conform the data in their records concerning the funeral director/direct disposer to the information
entered above.
___________________________________
________________________
Signature
Date signed
Form DFS-N1-1705; Change of Mailing Address or Contact Data-Entities
1 of 1
(Rev. 12/12); 69K-1.001
Page