Board of Accountancy

Individual Name Change

License Number:
Previous Name:
First:
Middle:
Last:
Suffix:
New Name: (How it will appear on your license)
First:
Middle:
Last:
Suffix:
Phone Number:
Email Address:
Number of Duplicate Copies of License
(Duplicate copies are $10 each.)

IMPORTANT:
In order to update your name, you must submit supporting documentation such as a copy of your marriage license or divorce decree. If your address has changed please submit the ONLINE ADDRESS CHANGE FORM OR EMAIL the Missouri State Board of Accountancy.

PLEASE MAIL TO:
Missouri State Board of Accountancy

P.O. Box 613, Jefferson City, Missouri 65102-0613
Phone: (573) 751-1102
Fax: (573) 751-0890
Email: mosba@pr.mo.gov

Code
Please type the numbers displayed above in the box below.