Doj Wis Concealed Form – Fill Out and Use This PDF

DJ-LE–285 (03/01/13) Concealed Weapon License—Change of address notification / Replacement license request

s. 175.60 Wis. Stats.

Change of Address: You must notify the Department of Justice (DOJ) of any address

Application Number

(DOJ Use Only)

change no later than 30 days after the change. Failure to do so may result in a forfei-

ture of $50, s. 175.60 (17)(ac), Wis. Stats. There is no cost to an address change

unless you request to have a new license issued by checking the replacement license

(DOJ Use Only)

box below.

Prior to submitting this form, notify the Department of Transportation of the

change to ensure the address on your photo identification will match the address on

your concealed carry license. DOT changes can be made at:

http://www.dot.wisconsin.gov/drivers/drivers/address-change.htm.

Lost or Destroyed License: If a license is lost or destroyed, the licensee may re-

quest a replacement by making a request and submitting a $12 fee, along with any re-

maining portions of the license to the DOJ.

Instructions

∙ Complete the licensee information below as it appears on your license.

∙ Enter your old and new address information below for change of address noti-

fications.

∙ Mail completed form to: Wisconsin Department of Justice

Attn: Firearms Unit P.O. Box 7130 Madison, WI 53707-7130

฀ Check here if requesting a replacement license

∙ You must include a check in the amount of $12 made payable to the Wiscon-

License Number

(DOJ Use Only)

sin Department of Justice for a replacement license pursuant to Jus 17.12(3).

∙ For a change of address, a new license will be mailed to you. If you did not

Date Updated

(DOJ Use Only)

return your previously issued license with this form you will be requested to

return it once you receive your replacement license.

∙ If your license was lost or destroyed making it impossible to return your exist-

Operator

(DOJ Use Only)

ing license, your existing license will be cancelled and must be returned if

found at a later time.

Concealed Carry License Number: (Optional if unknown and license was lost or stolen)

Date of Birth:

Last Name:

First Name:

Middle Name or Initial:

CHANGE OFADDRESS NOTIFICATION

Previous address as it appears on your license:

City:

State:

Zip Code:

New address: (P.O. Boxes alone are not acceptable)

City:

State:

Zip Code:

Signature of licensee

Date