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 Division of Mineral Mining

  Mineral Miner Certification Records

Change of Address Request


Use this form to update your mailing address in our records.  This information cannot be changed without a correct date of birth.

Your full name:
Your Date of Birth:  (mm/dd/yyyy)
Your Phone Number:

Your Old Address:
Street
City State Zip Code

Your New Address:
Street
City State Zip Code

Your email address: