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2. DATE*
   DATE
4. BLOCK*
5. LOT*
6. QUALIFIER
8. OWNER*
10. PROPERTY LOCATION*
12. NEW MAILING ADDRESS*
14. CITY*
15. STATE*
16. ZIP CODE*
18. PHONE NUMBER*
19. FAX NUMBER
21. EMAIL ADDRESS*
23. SIGNATURE*
    BY PRINTING NAME AND SUBMITTING FORM, YOU ARE TRUTHFULLY STATING THAT YOU ARE THE ABOVE-MENTIONED PROPERTY OWNER. YOU ARE ALSO AWARE THAT THIS WILL CHANGE YOUR MAILING ADDRESS FOR TAX BILLS AS WELL.
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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