行政许可变更申请书格式是怎样的

行政许可变更申请书

申请人：____________________________________________________________________________

地址：______________________________________________________________________________

法定代表人(委托代理人)：__________________________________________________________

申请变更事项：______________________________________________________________________

提交材料目录：

1、____________________________________________________________________________________________

2、____________________________________________________________________________________________

3、____________________________________________________________________________________________

4、____________________________________________________________________________________________

提交材料页数：_________________________________________________________________________________