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2. 

4. Note: This one form automatically goes to all of the internal departments that need to know, you do not need to fill out one for each department.
   Once you have hit "Submit" you will get a confirmation screen, if the submit button does nothing, review the required fields and try again.

6. PARCEL ID (1.)*

   (10 digit number)

7. Parcel ID 2. (if applicable)
8. Parcel ID 3. (if applicable)
10. PROPERTY LOCATION (911):*
12. PROPERTY OWNER(S)*
    (As shown on Deed or legal document)
14. NEW MAILING ADDRESS:*
    (Full address - Street or PO, City, State, and Zip code)
16. WILL THIS BE YOUR PRIMARY RESIDENCE MAILING ADDRESS:*

    (choose one)

    1. YES

    1. NO
18. OWNER PHONE #:*
    (xxx-xxx-xxxx)
19. EMAIL ADDRESS:
21. REQUESTER IS (please check one):*

    1. Owner
    2. Authorized Representative

    1. POA on file
    2. Company / Agency Official
23. OWNER(S) / REQUESTER'S NAME:*
    If printing form to send in, please print name, then sign. If submitting the form electronically, typing in your name is your signature.
24. REQUESTER'S PHONE #

    (If different from owner phone above)

26. DATE:*
    DATE:
30. Essex Town & Village of Essex Junction, VT
31. Websites: www.essexvt.org & www.essexjunction.org
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field