New York State
Department of State
Division of Licensing Services
P.O. Box 22001
Albany, NY 12201-2001
Customer Service: (518) 474-4429
CHANGE NOTICE
INSTRUCTIONS:
Use this form to report a change to a PERSONAL NAME, BUSINESS or RESIDENCE ADDRESS. If you wish to
receive a license/registration with your new name or address, you must submit a Duplicate License/Registration Request, form DOS-
1508. Otherwise, you may print the new name and/or business address directly on your license. Do not mail your license with this
form.
• If you are submitting a change to your personal name, you must provide acceptable forms of proof. Acceptable forms of proof include:
court order changing your name; marriage certificate or divorce decree; driver's license, or a non-driver's ID card; valid
passport; or immigration documents. If a personal name change is the result of a change in marital status, the fee is not required.
• Submit a separate form for each license you are changing. Mail this form with a check or money order made payable to the NYS
Department of State or charge the fee to MasterCard or Visa, using a Credit Card Authorization, form DOS-1450.
A $20 fee will be charged for any check returned by your bank.
Personal Name
Change of:
("X" only one)
Business Address
Residence Address
License/Registration Type:
("X" only one)
Apartment Information Vendor/Sharing Agent
FEE DUE: NONE
Appearance Enhancement Operator
Barber Operator
Shop/Area Renter
For personal name change only. Address changes require a $10.00 fee.
Appearance Enhancement Operator
Private Investigator
FEE DUE: $10.00
Bail Enforcement Agent
Real Estate Appraiser
Barber Operator
Real Estate Broker/Salesperson
For personal name change only. All other transactions must be performed through your eAccessNY
Document Destruction Contractor
account. A new license and photo ID card will automatically be issued for the license indicated below.
Hearing Aid Business
Security or Fire Alarm Installer
Hearing Aid Dispenser
Shop/Area Renter (Appearance Enhancement and Barber)
Notary Public
Watch, Guard or Patrol Agency
Pet Cemetery
FEE DUE: $25.00
Durable Juvenile Product Manufacturer
Armored Car Carrier
Bedding
Armored Car Guard
Central Dispatch Facility
Home Inspector
Telemarketer
Coin Processor
Security Guard
Ticket Reseller
Athlete Agent
UID/LICENSE NUMBER
EMAIL ADDRESS
NAME ON LICENSE (Last, First, M. I.)
NEW NAME (Last, First, M. I.)
NEW RESIDENCE ADDRESS (No. and Street required. P.O. Box may be added to ensure delivery)
CITY/STATE/ZIP
COUNTY
CITY/STATE/ZIP
COUNTY
NEW BUSINESS ADDRESS (No. and Street required. P.O. Box may be added to ensure delivery)
X
Print Name:
Signature:
Date:
DOS 1473-f (Rev. 03/15)