COMMONWEALTH OF VIRGINIA Department of Criminal Justice Services Attention: TOW TRUCK DRIVER REGISTRATION PO Box 1300, Richmond, VA 23218 Phone: (804) 367-0714 Fax: (804) 786-6344 • • Tow Truck Driver ADDRESS CHANGE FORM – IMPORTANT INFORMATION This request may take approximately 5 to 7 business days to process. Applicant Information DAD Number: Last Name: First Name: MI: Mailing Address (Street/Apt.#): City, State, Zip: Physical Address (if different than mailing address): City, State, Zip: Address: Home Phone: Business Phone: Fax: ( ) ( ) ( ) Affirmation I, the undersigned, certify that all information contained on this application is true and correct to the best of my knowledge and I have not omitted any pertinent information. I understand that any misrepresentation, falsification or omission of pertinent information may be cause for denial and may result in criminal charges. _________________________________________ Signature Required: Date: mm/dd/yy
COMMONWEALTH OF VIRGINIA Department of Criminal Justice Services Attention: TOW TRUCK DRIVER REGISTRATION PO Box 1300, Richmond, VA 23218 • Phone: (804) 367-0714 • Fax: (804) 786-6344 Tow Truck Driver – ADDRESS CHANGE FORM IMPORTANT INFORMATION This request may take approximately 5 to 7 business days to process. Applicant Information DAD Number: Last Name: First Name: MI: Mailing Address (Street/Apt.#): City, State, Zip: Physical Address (if different than mailing address): City, State, Zip: Address: Home Phone: ( ) Business Phone: ( ) Fax: ( ) Affirmation I, the undersigned, certify that all information contained on this application is true and correct to the best of my knowledge and I have not omitted any pertinent information. I understand that any misrepresentation, falsification or omission of pertinent information may be cause for denial and may result in criminal charges. Signature Required: _________________________________________ Date: mm/dd/yy
tow-truck-driver-address-change-form.docx