Commercial Drivers License
555 Wright Way, Carson City
810 E. Gregg St, Sparks, NV 89431
4110 Donovan Way, N Las Vegas, NV 89030
3505 Construction Way, Winnemucca, NV 89445
3950 E. Idaho St, Elko, NV 89801
178 N. Avenue F, Ely, NV 89301
CDL THIRD PARTY CHANGE NOTICE
Name of Company _________________________________________________________________
Company Certification Number __________________
Phone Number ___________________
Please check appropriate box and complete the information
Change of Address
Previous Address ____________________________________________________________
New Address ________________________________________________________________
Delete Company From Certification List
Number of vehicle less than twenty (minimum requirement)
Other (please explain) ______________________________________________________
Delete Certifier’s Name From Certification List
Name ______________________________________________________________________
Certification Number __________________________________________________________
Driver License Number ________________________________________________________
No longer employed by company
No longer has a valid class A or B commercial driver license
Other (please explain) _______________________________________________________
I certify the above information is true and correct, and that I am the authorized representative of the
above named company.
Signature ___________________________________________ Date ______________________
Name (Please print) ________________________________________________________________
CDL24 (3-2003)