Name/Phone/Email Change
of Facility
(No Inspection Needed If Owner is Not Changing)
Name of Facility Currently: ________________________________________
License #: _____________
New Name of Facility: _____________________________________________
Owner’s Signature: ________________________________________________
Please Mail or Email Signed Form Back to the Following:
Animal Welfare Section
Attention: Meghan Ray
1030 Mail Service Center
Raleigh, NC 27699
New Email Address:_______________________________________________
New Phone Number:______________________________________________
click to sign
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