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2. This notice of change is being submitted due to:*
4. THE UNDERSIGNED REQUEST THAT WE (DEPT. OF ASSESSMENT) NOTE OUR RECORDS TO REFLECT THE FOLLOWING CHANGES AS OF THIS DATE. ANY REQUEST AFTER WILL BE HONORED AS THE MOST RECENT AND UP TO DATE INFORMATION
6. AUTHORIZED SIGNATURE - OWNER / AGENT (INITIALS)*
8. NAME*
10. RELATIONSHIP TO OWNER*
11. TODAY'S DATE*
    TODAY'S DATE
13. PLEASE FILL THE FOLLOWING INFORMATION
15. PROPERTY ADDRESS*
17. MAP PAGE ID. OR BLOCK AND LOT:*
19. OWNER'S NAME*
21. EMAIL ADDRESS*
23. CONTACT PHONE NUMBER*
25. *********NEW MAILING ADDRESS FOR TAX BILLS*********
27. C/O NAME*
29. Address*
31. City*
32. State*
33. Zip Code*
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field