"Address Change Request Notice" - Arizona

Address Change Request Notice is a legal document that was released by the Arizona State Land Department - a government authority operating within Arizona.

Form Details:

  • Released on April 1, 2010;
  • The latest edition currently provided by the Arizona State Land Department;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Arizona State Land Department.

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Download "Address Change Request Notice" - Arizona

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ARIZONA STATE LAND DEPARTMENT
1616 West Adams Street
Department Use Only
Phoenix, AZ 85007
__________
P/R
(Initial)
___________________
(Date)
Rolodex #:
ADDRESS CHANGE REQUEST NOTICE
___________________
To change your address, for legal and security purposes a written request must be submitted to the Arizona State Land
Department specifying the following information:
1.
Indicate the lease or permit number(s) which will require an address change.
2.
The previous address which the Arizona State Land Department has on record.
3.
The new address at which you wish to have all correspondence and billing mailed by the Arizona State Land
Department.
4.
Signatures(s) of all the lessee or permittees who are named on the original lease or permit; or the person who
has been authorized through a Power of Attorney, or named by the Court to sign on behalf of the lessee or
permittee (These documents must be in the records of the Arizona State Land Department.)
5.
Return to:
Arizona State Land Department
ATTN: Public Records
1616 W. Adams Street
Phoenix, AZ 85007
LEASE OR PERMIT NO.
_____-____________________-______
______-_____________________-________
______-____________________-_____
______-_____________________-________
_____-____________________-______
______-_____________________-________
OLD ADDRESS:
NEW ADDRESS:
____________________________________________
____________________________________________
Lessee
Lessee
____________________________________________
____________________________________________
Mailing Address
Mailing Address
____________________________________________
____________________________________________
City
State
Zip
City
State
Zip
(_____)______________________________________
(_____)______________________________________
Phone
Phone
By: _____________________________
______________________
Signature
Date
_____________________________
______________________
Signature
Date
_____________________________
______________________
Signature
Date
_____________________________
______________________
Signature
Date
Address Change 10/02 (Rev. 4/10)
ARIZONA STATE LAND DEPARTMENT
1616 West Adams Street
Department Use Only
Phoenix, AZ 85007
__________
P/R
(Initial)
___________________
(Date)
Rolodex #:
ADDRESS CHANGE REQUEST NOTICE
___________________
To change your address, for legal and security purposes a written request must be submitted to the Arizona State Land
Department specifying the following information:
1.
Indicate the lease or permit number(s) which will require an address change.
2.
The previous address which the Arizona State Land Department has on record.
3.
The new address at which you wish to have all correspondence and billing mailed by the Arizona State Land
Department.
4.
Signatures(s) of all the lessee or permittees who are named on the original lease or permit; or the person who
has been authorized through a Power of Attorney, or named by the Court to sign on behalf of the lessee or
permittee (These documents must be in the records of the Arizona State Land Department.)
5.
Return to:
Arizona State Land Department
ATTN: Public Records
1616 W. Adams Street
Phoenix, AZ 85007
LEASE OR PERMIT NO.
_____-____________________-______
______-_____________________-________
______-____________________-_____
______-_____________________-________
_____-____________________-______
______-_____________________-________
OLD ADDRESS:
NEW ADDRESS:
____________________________________________
____________________________________________
Lessee
Lessee
____________________________________________
____________________________________________
Mailing Address
Mailing Address
____________________________________________
____________________________________________
City
State
Zip
City
State
Zip
(_____)______________________________________
(_____)______________________________________
Phone
Phone
By: _____________________________
______________________
Signature
Date
_____________________________
______________________
Signature
Date
_____________________________
______________________
Signature
Date
_____________________________
______________________
Signature
Date
Address Change 10/02 (Rev. 4/10)