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Branch Office ($50.00 fee) Change Business Name ($10.00) Change Location Same County ($10.00) Current Business Name Current Business Phone Current Trade (DBA) Name County ( Current Business Address ) City State Zip New Business Name New Business Phone New Trade (DBA) Name County ( ) New Business Address City State Zip Mailing Address City State Zip Licensee Phone ( Business Contact Name (first, middle, last, suffix) Phone Number Fax Number ( ( ) ).

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