Change Of Mailing Address Only

New Mexico Regulation and Licensing Department Toney Anaya Building PO Box 25101 Santa Fe, New Mexico 87504-5101 (505) 476-4875 Fax (505) 476-4595 www.rld.state.nm.us/alcoholandgaming ALCOHOL AND GAMING DIVISION CHANGE OF MAILING ADDRESS ONLY FORM No fee for address change MAILING ADDRESS CHANGE FOR LIQUOR LICENSES: Should a change in physical address occur for a Liquor License establishment, contact a hearing officer for Change of Location information. LIQUOR LICENSE NO.: _______________________ Name of Licensee: ___________________________________________________________________________ DBA: _____________________________________________________________________________________ New Mailing Address: ________________________________________________________________________ City: ____________________________________ State: _____________________ Zip: ___________________ I am the: Owner Resident Agent for owner Cell Number: ________________________________ Phone Number: ________________________________ Email Address: ______________________________________________________________________________ Printed Name: _______________________________________________________________________________ Signature: ______________________________________________________ Date: _______________________ MAILING ADDRESS CHANGE FOR SERVERS: PERMIT NO. _____________________ First Name: _______________________________ Last Name: ________________________________________ New Mailing Address: ________________________________________________________________________ City: _____________________________________ State: _____________________ Zip: __________________ Phone Number: ______________________________ Cell Number: _________________________________ Email Address: ______________________________________________________________________________ Server's Signature: _______________________________________________ Date: ______________________ Mail this Form to: PO Box 25101 Santa Fe, NM 87504-5101 Physical Location: Toney Anaya Building, 2550 Cerrillos Road Santa Fe, NM 87504 Phone: (505) 476-4875 Fax: (505) 476-4595 ALCOHOL & GAMING DIVISION USE ONLY: Servers| Permit No. ____________________ Expires on: _______________________ Citations/Holds: ____________ Processed By: ______________________________________________________ Date: ________________________ Notice Sent on:__________________________ By: Email 1st class mail Fax Phone Revised 5/3/2016 American LegalNet, Inc. www.FormsWorkFlow.com