Kansas Board of Mortuary Arts

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Change of Address Form

 

Name:

Embalmer License Number:

Funeral Director License Number:

Assistant Funeral Director License Number:

Funeral Home employed at: 


PREVIOUS INFORMATION

Previous Address:

Previous City:

Previous State:

Previous Zip:

Previous Telephone Number:

 

CURRENT INFORMATION

Current  Address:

Current  City:

Current State:

Current Zip:

Current Telephone Number:

Cell Telephone Number:

E-mail Address:

 


State of Kansas Board of Mortuary Arts

700 SW Jackson Street, Suite 904   -  Topeka, Kansas 66603-3733
phone:(785)-296-3980  -  fax:(785)296-0891
 -  email: boma1@ksbma.ks.gov

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