Address Change Request Form

    All Fields Required

    Owner’s Name

    Grid Number

    Physical Address of Parcel

    Old Address

    New Address

    I agree to submit this application by electronic means. By signing this application electronically, I certify under penalty of perjury and false swearing that my answers are all correct and complete to the best of my knowledge. I also certify that I understand the questions and statements on this application. I understand the penalties for giving false information. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

    First Name

    Last Name

    Email Address

    Contact Us

    Monday – Tuesday: 9:00 am to 3:00 pm

    Amanda Chamberlin, Clerk
    (845) 373-8118 ext. 104
    fax (845) 373-8140