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Name / Address Change Request Form

2. Date*

4. First Name*

5. Last Name*

7. *If not the taxpayer of record, a deed, land contract, divorce judgement or letter of authorization must be attached.

   *If not the taxpayer of record, a deed, land contract, divorce judgement or letter of authorization must be attached.

9. Address of Subject Property*

11. Parcel I.D. Number

13. Is this a temporary or permanent change?*

15. Is the property your principle residence?*

17. Is the property rented / leased?*

19. 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.

21. Reason for Change*

23. Name Change From

25. Name Change To

27. Current Mailing Address

29. New Mailing Address

31. Phone Number*

32. Cell Phone Number

34. Property Owners Signature*

36. PLEASE COMPLETE THE FORM ENTIRELY AND RETURN TO CITY OF DAVISON, CITY HALL.

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

* indicates a required field