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BOARD NOTES - Texas State Board of Veterinary Medical Examiners

BOARD NOTES - Texas State Board of Veterinary Medical Examiners

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Page 13<strong>BOARD</strong> <strong>NOTES</strong>NOTICE OF ADDRESS CHANGEPlease email, fax, or mail to:<strong>Texas</strong> <strong>Board</strong> <strong>of</strong> <strong>Veterinary</strong> <strong>Medical</strong> <strong>Examiners</strong>333 Guadalupe, Suite 3-810Austin, <strong>Texas</strong> 78701FAX: 512-305-7556Email: vet.board@tbvme.state.tx.usPlease print or typeNameLicense Number ________________Mailing Address:Street/PO BoxCity, <strong>State</strong>EmailPractice Address:Practice NameStreetCity, <strong>State</strong>PhoneEmailFaxZip CodeZip CodeHome Address:StreetCity, <strong>State</strong>Home PhoneEmailCell PhoneZip CodeNote: The mailing address is the default address. All documents, forms and letters sent to youfrom this agency will be mailed to this address.The mailing address is printed on your license renewal certificate. If you have changed yourmailing address and need a duplicate renewal certificate, please indicate below.___ Please send a duplicate renewal certificate.Pursuant to <strong>Board</strong> Rule 573.76(a) “A veterinarian shall notify the <strong>Board</strong> <strong>of</strong> any change <strong>of</strong> any items in subsection (a)not later than the 60th day after the change takes place.” Subsection (a) includes: name and license number; clinic orpractice name; physical business address; mailing address; residence address; business telephone number; andresidence and/or cellular telephone number.

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