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Request for Change of Mailing Address - Town / Village of Essex

2. 

4. PARCEL ID#(s)*

6. PROPERTY LOCATION (911):*

8. NEW MAILING ADDRESS:*

10. City*

11. State*

12. Zip Code*

14. OWNER PHONE #:*

    (xxx-xxx-xxxx)

16. EMAIL ADDRESS:

18. REQUESTER IS (please check one):*

    1. Owner
    2. Authorized Representative

    1. POA on file
    2. Company / Agency Official
20. 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.

22. DATE:*
    DATE:

26. This section for Office Use Only

    Request made (check one):

    1. Returned Mail

    1. Phone

    1. In Writing

    1. Web Submittal
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