REQUEST FOR CHANGE OF ADDRESS

NAME:  _______________   __________   _________________________________
                  (First)                                             (M.I.)                   (Last)

MAILING ADDRESS:   ____________________________________________

                                     ___________________________   ________  ____________
                                        (City)                                                                              (ST)                (Zip)

EMAIL:  ___________________________________________________________

TELEPHONE:  (____________) ______________ - ______________________

Parcel Number(s):  ____________________________________________________________
                        __________________________________________________________
                        __________________________________________________________
                        __________________________________________________________

REASON FOR CHANGE:  _____________________________________________________
______________________________________________________________________

Illinois Compiled Statutes: (35 ILCS 200/20-20) Sec. 20-20. Changes in address for mailing tax bill. No change of address shall be  implemented unless the person requesting the change is the owner of the property, a trustee or a person holding the power of attorney from the owner or trustee of the property.  However, if a property owner conveys a permanent change of address in writing  to the United States Postal Service, then, on or after the effective date of  that change of address, the county collector may mail a property tax bill to the property owner at his or her new address regardless of whether or not the owner notifies the collector of the address change.

I Certify that I am the owner, trustee, or person holding Power of Attorney for the owner and I authorize the above address change:   
               
      _______________________________________________   ________________
                     (Signature)                                                                                                         (Date)

RETURN COMPLETED & SIGNED FORM TO: Madison County  CCAO 157 N. Main Street, Suite 229                                                   Edwardsville, IL  62025 Email: ccaoforms@madisoncountyil.gov

OFFICE USE ONLY:   Date Received:                     INT: _______________