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Division Director

Sha'Ron James


Division of Rehabilitation and Liquidation
Alexander Bldg.,
2020 Capital Circle SE, Ste. 310
Tallahassee, FL 32301
1-800-882-3054
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Instruction Sheet for Name and or Address Changes

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Haz clic aquí para ver las instrucciones en español.

Please follow the instructions below to obtain the forms required in order to submit a request to the Receiver to have a name and/or address changed in claim records.

All the forms involving changes to the name and/or address on a claim record are linked below the instructions. Please review the instructions carefully as to what forms and supporting documentation is required based on the reason for your change request.

All completed forms and supporting documentation should be mailed to:

The Department of Financial Services,
Division of Rehabilitation and Liquidation
Attention: Claims Dept. – Change of Name and/or Address
2020 Capital Circle SE, Ste 310
Tallahassee, FL 32301

Documents to support your request, as specified below, must accompany the required forms.

The Receiver reserves the right to validate any name and/or address change request received and may request additional information from you.

Please contact us if you have questions by clicking on the "Contact Us Form" in the website’s navigation pane or you may call Consumer Services at 800-882-3054.


A. Address Change ONLY (for name changes, see other choices listed below)
a. Please complete the Claimant Address Change Only Request Form and send it in with these documents:

  • If you are an individual: a copy of valid driver license, utility bill, passport, or other photographic legal identity document that contains the address you have entered on your form.
  • If you are an unincorporated business: a utility bill, an occupational license or bank statements that contain the address you have entered on your form.
  • If you are an incorporated business: a copy of most recent filing with Secretary of State (www.sunbiz.org), or other filing that contains the address you have entered on your form.

B. Name Change due to MARRIAGE (with or without address change)
a. Please complete the Claimant Name Change Request Form With or Without Address Change and send it in with one of these documents: (documents must reflect the same name and address being requested):

  • Copy of valid driver license, or
  • Utility bill, or
  • Passport, or other photographic legal identity document, or
  • Copy of marriage certificate

C. Name Change due to DEATH (with or without address change)
a. Please complete the Claimant Name Change Request Form With or Without Address Change and send it in with these documents (documents must reflect the same name and address being requested):

  • Copy of valid driver license or other photographic legal identity document for individual requesting name change, and
  • Copy of death certificate, and
  • If the total amount of the claim is less than $5,000, a properly executed Name-Address Estate Under 5000 Affidavit, or
  • If the total amount of the claim is more than $5,000, a certified copy of court order identifying beneficiaries, or documents from probate that reflect this information, copy of will and Petition for Discharge or appointment of personal representative.

D. Name Change due to DIVORCE (with or without address change)
a. Please complete the Claimant Name Change Request Form With or Without Address Change and send it in with these documents (documents must reflect the same name and address being requested):

  • Copy of valid driver license, utility bill, passport, or other photographic legal identity document, and
  • Copy of divorce agreement, and
  • A properly executed Divorce Affidavit

E. Name Change for ACTIVE COMPANIES or Corporations (with or without address change)
a. Please complete the Claimant Name Change Request Form With or Without Address Change and send it in with these documents (documents must reflect the same name and address being requested):

  • Copy of valid driver license or other photographic legal identity document for individual requesting name change, and
  • If incorporated, copy of most recent filing with Secretary of State (www.sunbiz.org), or filing that reflects name change, or
  • If not listed with Secretary of State submit signed statement by a listed officer authorizing payment, corporate bylaws reflecting authorization or corporate resolution reflecting individual’s authority to act on behalf of company

F. Name Change for INACTIVE OR DISSOLVED COMPANIES or Corporations (with or without address change)
a. Please complete the Claimant Name Change Request Form With or Without Address Change and send it in with these documents (documents must reflect the same name and address being requested):

  • A copy of valid driver license or other photographic legal identity document for individual requesting name change, and
  • Documentation that will clearly verify the connection between the individual and the dissolved company or corporation, such as tax filings, occupational license, bank statements, etc., and
  • A properly executed Name-Address Inactive or Dissolved Company Affidavit, and
  • If owner deceased, a properly executed Name-Address Inactive or Dissolved Company Estate Affidavit, and
  • If incorporated, a copy of last filing with Secretary of State (www.sunbiz.org) identifying officers, or
  • If not listed with Secretary of State, submit signed statement by a listed officer authorizing payment or corporate bylaws reflects authorization or corporate resolution authorizing Receiver to conduct a bankruptcy search to confirm no creditors exist for dissolved company

G. Name and Address Change due to an ASSIGNMENT OF CLAIM

  • Please submit a properly executed Assignment of Claim Change Request Form, and
  • Submit a properly executed Claim Assignment Agreement
  • Please be advised that Assignments of Claim will not be accepted after the distribution petition has been filed with the Court
  • Both the form and the agreement must be signed and notarized with no information obscured, altered or redacted
  • If the claimant on file with the Receiver is not an individual, the change forms should be signed by an individual with the authority to sign on behalf of the company/corporation/doctor’s office etc. If the individual is not a listed officer on the Secretary of State filing, supporting documentation confirming the person is authorized to act on the claimant’s behalf must be submitted.
  • If the claimant name and/or address on file with the Receiver differs from their current name and address, please comply with the requirements listed above and submit this additional information with your request.

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