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