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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.

   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. Does this parcel currently receive an exemption (senior or person with disability)*

    1. Yes
    2. No

20. Phone Number*

21. Do you need a new tax statement?*

    1. Yes
    2. No

23. Date:
    Date:

24. Person Requesting Change:*

26. Relation to Owner:*
    -- Select One --SelfSpouse of OwnerChild of OwnerPersonal RepresentativeOther

27. Personal Representatives: Please leave cause number.

    Others: Please explain

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field