Concealed Carry

Change of Name or Address Notification Form

Enter your name exactly as it appears on your Concealed Carry License.

First Name

Middle Name

Last Name

Email Address

Birth Date

MM/DD/YYYY

License Number

K00-00-0000

Last four digits of social security number

Name Change

First Name

Middle Name

Last Name

Address Change

Old Address

Address

City

State

ZIP

New Address

Address

City

State

ZIP

County

Mailing Address

If different from residence address. (i.e. PO Box)

Address

City

State

ZIP

Verification

I declare and verify under penalty of perjury and the laws of Kansas that all of the foregoing information is true and correct to the best of my knowledge.

Please certify your agreement to the above statement by typing your full name in the box below: