"Change of Address Request Form" - New York City

Change of Address Request Form is a legal document that was released by the New York City Department of Transportation - a government authority operating within New York City.

Form Details:

  • The latest edition currently provided by the New York City Department of Transportation;
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  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the New York City Department of Transportation.

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NYC Department of Transportation
Permits & Customer Service-PPPD Unit
30-30 Thomson Avenue, 2nd Floor
(Entrance on 30th Place, near 47th Avenue)
Long Island City, New York 11101-3405
(718) 433-3100, TTY (212) 504-4115 nyc.gov/dot
Change of Address Request Form
 
I
_________________________________________request to update my records as follows:
 
City Permit #:
State Permit #:
 
Check here if you have both a City and State Parking Permit for People with Disabilities
 
Previous Home Address:
Apt. #:
City:
State:
Zip Code:
 
 
Current Home Address:
Apt. #:
City:
State:
Zip Code:
Please check your preferred method of contact below:
Home Phone Number:
Mobile Device Number:
 
Email address ________________________________________________________
 
 
Please provide any two (2) documents from the list below, as proof of new residence. All
documents must be in the applicant's name, be dated within the last 90 days, and have
account numbers and account balances crossed out. All documents must be mailed in
or brought in with the application
 
• Utility Bills (Electricity, Gas, Water, Oil)
 
• Telecommunications Bills (Telephone, Mobile Device, Cable or Satellite Television)
 
• Residence (Home Mortgage Statement, Lease Agreement, NYCHA Rent Receipt, United States
Postal Service Address Verification Letter)
 
• Banking/Credit Card Statements (Banks, Credit Cards, Major Store Cards)
 
• Social Security Award Letter
 
I declare this information provided is correct and I give NYCDOT Permits & Customer Service
the right to make the request for address change for their records.
 
 
Date:
/
/
Signature of Person with the Disability
(If Driver’s License or Non-Driver’s ID indicates “Unable to Sign”, please leave
blank. Parent or guardian may sign for a minor child)
 
 
Please note: If the Permit Holder is a minor, two proofs of residence in parent(s) or guardian(s)
name are acceptable. Proof of residence from a nursing home/assisted living facility or letter
indicating school attendance is also accepted as sole verification.
 
 
For Official Use Only 
□  City            □  State 
□  Address verified 
NYC Department of Transportation
Permits & Customer Service-PPPD Unit
30-30 Thomson Avenue, 2nd Floor
(Entrance on 30th Place, near 47th Avenue)
Long Island City, New York 11101-3405
(718) 433-3100, TTY (212) 504-4115 nyc.gov/dot
Change of Address Request Form
 
I
_________________________________________request to update my records as follows:
 
City Permit #:
State Permit #:
 
Check here if you have both a City and State Parking Permit for People with Disabilities
 
Previous Home Address:
Apt. #:
City:
State:
Zip Code:
 
 
Current Home Address:
Apt. #:
City:
State:
Zip Code:
Please check your preferred method of contact below:
Home Phone Number:
Mobile Device Number:
 
Email address ________________________________________________________
 
 
Please provide any two (2) documents from the list below, as proof of new residence. All
documents must be in the applicant's name, be dated within the last 90 days, and have
account numbers and account balances crossed out. All documents must be mailed in
or brought in with the application
 
• Utility Bills (Electricity, Gas, Water, Oil)
 
• Telecommunications Bills (Telephone, Mobile Device, Cable or Satellite Television)
 
• Residence (Home Mortgage Statement, Lease Agreement, NYCHA Rent Receipt, United States
Postal Service Address Verification Letter)
 
• Banking/Credit Card Statements (Banks, Credit Cards, Major Store Cards)
 
• Social Security Award Letter
 
I declare this information provided is correct and I give NYCDOT Permits & Customer Service
the right to make the request for address change for their records.
 
 
Date:
/
/
Signature of Person with the Disability
(If Driver’s License or Non-Driver’s ID indicates “Unable to Sign”, please leave
blank. Parent or guardian may sign for a minor child)
 
 
Please note: If the Permit Holder is a minor, two proofs of residence in parent(s) or guardian(s)
name are acceptable. Proof of residence from a nursing home/assisted living facility or letter
indicating school attendance is also accepted as sole verification.
 
 
For Official Use Only 
□  City            □  State 
□  Address verified