1

Address/Name Change Notification

Please note: This form is only for gaming professionals. If you don't have a Colorado Gaming License do not fill out this form.

If you are a healthcare or occupational professional you can change your address with the the Division of Professions and Occupations at this link: https://dpo.colorado.gov/UpdateContact

 

Address Change
New Street Address
Mailing Address
Name Change

Status message

Reason for Name Change (select one):

Status message

Submit a copy of the legal documentation reflecting the name change.  Acceptable forms of documentation include:  marriage license, divorce decree, court order, immigration records, or passport. E-mail documentation to Brenda Fredricey at brenda.fredricey@state.co.us, or fax to (303) 205-1342. Please contact Brenda with any questions at (303)866-3442.