Request for Address Verification

2. Address Needing Verification
   Please enter the address needing verification.
4. Contact Information
6. Business Name
8. Name*
9. Email Address*
11. Address*
13. City*
14. State*
15. Zip Code*
17. Phone Number*
18. Fax Number
20. Verification recipient differs from the above.

    1. Enter Different Recipient

    *Select To Enter Information Below
22. Business Name
24. Name*
25. Email Address*
27. Address*
29. City*
30. State*
31. Zip Code*
33. Phone Number*
34. Fax Number
36. Required Information*

    Please select one of the following:

    1. I have a parcel ID number.
    2. I have a Warranty Deed. (Upload file below.)
    3. I have the Lot Number, Block Number, and Subdivision Name.
    4. I have a Survey or other document. (Upload file below.)
38. Enter Parcel ID*
40. Enter Subdivision Name, Block Number, and Lot Number*
42. Upload Warranty Deed or Survey (if applicable)
44. Request verification be placed on city letterhead.

    1. Yes
    2. No
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

* indicates a required field