Change Of Address And Contact Information

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CHANGE OF ADDRESS
and CONTACT INFORMATION
ACCOUNT NAME
Please check one or both and provide the account number(s):
( ) IRP ACCOUNT #
( ) IFTA ACCOUNT #
OLD ADDRESS INFORMATION
Physical
Mailing
Telephone Number:
Telephone Number:
NEW ADDRESS and CONTACT INFORMATION
Physical
Mailing
Telephone Number:
Telephone Number:
Name of New Contact (if applicable)
Change or Cancel Power of Attorney? YES  NO  New Power of Attorney is Enclosed? YES  N/A 
* PROOF OF RESIDENCY – To change your
Signature______________________________________________
physical address, you must include three
Title___________________________Date___________________
items from the following list with this
completed form.
Current copy of a Florida driver’s license in your name.
Copy of a document indication your company is a Florida corporation or is registered to conduct business as a foreign corporation in Florida.
Copy of document indicating you are a resident of Florida and the principal owner of a Florida corporation.
Current copy of a Federal income tax return, in your name, indication the return was filed from your Florida address.
Current copy of a tax bill indicating real estate or personal property taxes have been paid in your name for your Florida address.
Current copy of a utility bill paid in your name for your Florida address.
Copy of a vehicle title or registration for a vehicle titled in Florida in your name.
NOTE:
A change to your physical address requires issuance of a new cab card.
Please enclose $3.25 per vehicle.
MAIL COMPLETED FORM AND ANY OTHER ENCLOSURES TO:
Bureau of Commercial Vehicle and Driver Services – Neil Kirkman Building, MS 62
2900 Apalachee Parkway – Tallahassee, FL 32399-0626
Telephone (850) 617-3711 – FAX (850) 617-3931 –
OUR MISSION
PROVIDING HIGHWAY SAFETY AND SECURITY THROUGH
EXCELLENCE IN SERVICE, EDUCATION, AND ENFORCEMENT
OUR VISION
A SAFER FLORIDA!
HSMV 85041 Rev. 12/14

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