请问一下行政许可变更申请书格式是怎样的

请问一下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：________________________________________________________________________________。