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Name / Address Change Request Form

Date*
First Name*
Last Name*
*If not the taxpayer of record, a deed, land contract, divorce judgement or letter of authorization must be attached.
Address of Subject Property*
Parcel I.D. Number
Is this a temporary or permanent change?*
Is the property your principle residence?*
Is the property rented / leased?*
Is the change requested a result of a recent sale / transfer of ownership?*
*IF YES, A COPY OF THE COMPLETED PROPERTY TRANSFER AFFADAVIT MUST BE ATTACHED FOR THIS REQEUST TO BE PROCESSED.
Reason for Change*
Name Change From
Name Change To
Current Mailing Address
New Mailing Address
Phone Number*
Cell Phone Number
Property Owners Signature*
PLEASE COMPLETE THE FORM ENTIRELY AND RETURN TO CITY OF DAVISON, CITY HALL.

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Name / Address Change Request Form