Microsoft Word - 1473-f.docx

 Appraisal Management Company (Owner/Controlling person name or personal address ONLY)

 Barber Operator

New York State

Department of State

Division of Licensing Services

P.O. Box 22001

Albany, NY 12201-2001

Customer Service: (518) 474-4429

https://dos.ny.gov

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.

• Appraisal Management Companies, Appearance Enhancement and Barber Shop Businesses may submit a name change if business

structure will not change.

• 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.

Change of: Business Name (Appraisal Management Company, Appearance Enhancement & Barber Shop ONLY)

("X" only one)

Personal Name

Business Address

Residence Address

License/Registration Type:("X" only one)

 Apartment Information Vendor/Sharing Agent  Armored Car Guard  Nail Specialty Trainee FEE DUE: NONE

 Appearance Enhancement Operator *  Barber Operator  Security Guard

 Shop/Area Renter * For personal name change only. Address changes require a $10.00 fee.

 Appearance Enhancement Operator  Private Investigator FEE DUE: $10.00

 Appraisal Management Company  Real Estate Appraiser

(Business name or Business address ONLY)

 Bail Enforcement Agent  Real Estate Broker/Salesperson *For personal name change only. All other transactions

must be performed through your eAccessNY account. A new license and

photo ID card will automatically be issued for the license indicated below.

 Document Destruction Contractor  Pet Cemetery

 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

 Armored Car Carrier  Central Dispatch Facility  Home Inspector FEE DUE: $25.00

 Athlete Agent  Coin Processor  Ticket Reseller

 Bedding  Durable Juvenile Product Manufacturer  Telemarketer

 Appearance Enhancement Business name change  Barber Shop Business name change FEE DUE: $30.00

UID/LICENSE NUMBER EMAIL ADDRESS

NAME ON LICENSE (Last, First, M. I.) OR (AE BUSINESS NAME) NEW NAME (Last, First, M. I.) OR (AE BUSINESS NAME)

NEW RESIDENCE ADDRESS (No. and Street required. P.O. Box may be added to ensure delivery) CITY/STATE/ZIP COUNTY

NEW BUSINESS ADDRESS (No. and Street required. P.O. Box may be added to ensure delivery)

CITY/STATE/ZIP

COUNTY

Print Name: Signature:

X

Date:

DOS-1473-f (Rev. 09/21)