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Get 7570 Norman Rockwell Lane, Suite 230 Las Vegas, Nv 89143 - Ptboard Nv

640.055, if a licensee changes his name after his license is issued, he must submit, within 30 days after the change, proof satisfactory to the Board that his name was legally changed. If the change of name resulted from marriage or a court decree, a copy of the marriage certificate or court decree must be submitted to the Board. In that regard, you may use this form to change your name with the Board. Please provide a copy of the appropriate legal document, this completed form, and a check or m.

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