Change of Address Notice by qbQK4BBT

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									                                         STATE OF NEW MEXICO
               PUBLIC EDUCATION DEPARTMENT — JERRY APODACA EDUCATION BUILDING
                                    EDUCATOR ETHICS BUREAU
                                        300 DON GASPAR
                                 SANTA FE, NEW MEXICO 87501-2786
                                              www.ped.state.nm.us


DR. VERONICA C. GARCIA                                                          BILL RICHARDSON
SECRETARY OF EDUCATION                                                              GOVERNOR




                                          Change of Address Notice


    Date________________


                                                                     File # ____________,


    I *________________________________ who’s Social Security # is *________________,
     (Please print name)

    Hereby notify the Public Education Department of a recent address change.

    Former address was:           *_________________________________
                                   _________________________________
                                   _________________________________

    New Address is:              *__________________________________
                                  __________________________________
                                  __________________________________

    Thank you,


    *
    Signature required for processing.


    Return Form to the:
           Public Education Department
           Attn: Professional Licensure
           300 Don Gaspar Rm. #105
           Santa Fe, NM 87501
           OR Fax to: 827-4148

    *Required Fields

								
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