Required fields are marked with asterisks (*)

Name and Address Change Form

Please complete this form - ensure proper documentation is attached

Documentation required

Change of Name - must be supported by Drivers Licence; Marriage Certificate; Divorce decree etc.

Please contact the Tax Department if you require furhter information 613-967-3200 ext 3243 or 3226

Tax Roll Number

DATE (MM/DD/YYYY)

Property Owner Name

Property Address;

Change Name to;

Change Mailing Address to;

Email Address:

Additonal Comments

Signature

Clear

Personal Information on this form is collected under the authority of the Municipal Act 2001, SO 2001, c25 will be used to process your Modification request. Questions about the collection of this personal information only should be directed to the Manager of Taxation, Taxation Department, 169 Front Street, Belleville, ON K8N 2Y8 613-967-3241

THIS FORM CANNOT BE USED FOR CHANGE OF LAND TITLE

Attach copy of drivers license/marriage certificate if applicable

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