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ADDRESS CHANGE REQUEST FORM

2. NOTE: THIS FORM IS SOLELY FOR THE PURPOSE OF MAILING A TAX STATEMENT. IT DOES NOT CHANGE OWNERSHIP OR VESTING. ADDRESS CHANGES CAN ONLY BE SUBMITTED BY THE OWNER OF RECORD OR THEIR AGENT/LEGAL REPRESENTATIVE.
4. Parcel Number(s):*
   Include all parcels, separated by a comma.
7. First Name*
8. Last Name*
9. MAIL IN CARE OF:
11. Address1*
13. Address2
15. City*
16. State*
17. Zip*
19. Your Email Address
21. Does this parcel currently receive an exemption (senior or person with disability)*

    1. Yes
    2. No
22. Phone Number*
23. Do you need a new tax statement?*

    1. Yes
    2. No
25. Date:
    Date:
26. Person Requesting Change:*
28. Relation to Owner:*
    -- Select One --SelfSpouse of OwnerChild of OwnerPersonal RepresentativeOther
29. Personal Representatives: Please leave cause number.
    Others: Please explain
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field