Address Change Request (Assessment Office)

REQUEST FOR CHANGE OF ADDRESS THIS FORM WILL CHANGE THE MAILING ADDRESS ONLY, NOT OWNERSHIP OF THE PROPERTY . PARCEL NUMBER: __ __ - __ __ - __ __ __ - __ __ __ NAME: ___________________________________________________________________ CURRENT ADDRESS: ______________________________________________________ ____________________________ City IL State ____________ Zip NEW MAILING ADDRESS: __________________________________________________ ____________________________ ____ City State _____________ Zip REASON FOR CHANGE: ______________________________________ Please check if this property will no longer be your principal residence. Exemptions will be removed the following January 1. THIS FORM MUST BE SIGNED BY THE OWNER OF RECORD OR AUTHORIZED REPRESENTATIVE AS NOTED BELOW FOR ACCEPTANCE OF THE ABOVE ADDRESS CHANGE. I certify that I am the owner, trustee or person holding Power of Attorney (copy of POA must be attached) for the owner and I authorize the above address change: Signature _________________________________________ Signature _________________________________________ Daytime Phone for owner or agent ____________________ Date ____________ Date ____________ RETURN COMPLETED FORM TO: CHIEF COUNTY ASSESSMENT OFFICE DEKALB COUNTY ADMINISTRATION BUILDING 110 E. SYCAMORE STREET SYCAMORE, IL 60178 815-895-7120 (PHONE) 815-895-1684 (FAX) American LegalNet, Inc. www.FormsWorkFlow.com