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Request for Mailing Address Change

  1. City of Portage 2013 LogoWEBSAFE
  3. Name of Requesting Party:
  5. I hereby request that the mailing address of the parcel(s) noted above be changed; I certify that I am the property owner or I have been authorized by the property owner to request the changes(s). Also, I understand that any mailing address change will apply to property tax billing only, If I wish to change a mailing address for utility billing or voter registration purposes. I will make a request for this change at the appropriate department (Finance Department for utility billing & City Clerk's Office for voter registration). Disclaimer: Information submitted on this form will be sent via email. To protect sensitive information, do not request the following information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, and passwords.
  6. Automatically update Utilities with Treasury?
  7. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  9. This field is not part of the form submission.