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Addressing Change 2008-4-10 (2)
.. ~ SPRINGFIELD 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ADDRESS CHANGE REQUEST Property Owner: '5 ~'E> V'\... ~ l~\.>-("'\'..Q... w: \$~ N. Mailing Address: S L'84 'I ~ \.+,q ~ Ba: ~ L~ QrL . ..... City: SPt"''^j{'p/LJ State: f) lit Zip: '1lL! 1 ~ Person or Agency requesting change if other than owner: Phone number where you can be contacted between 1 :OOpm and 5:00pm: s4 \ - ~~Co --tis I ~ \..o..u..v,'~ COSle, -L-/~ \ 2- Address of property you are requesting to be changed: 5~ LI2- W-t'~\.. ~ Q J <;rvl'nPj~'" Ld FlI2-. ql'-t1~ Assessor Map #: \ I D 7'" ~'6 3. ~ Tax Lot #: (D' Please explain specifically why you feel the address needs to be changed: W ~+ vSU ..+t:. kle -\\.te r!f'j'J-t- Waf \'"",h bux r rn pp~~ i' ,<; now '33 .-d ~+. 1~~ ~V'e... ~u..Ht~~ ,~"\. ~~\lefa\ ho.up~ \oP..."'~>'\.J \).s. 1't..P 01'\ \'1 '" u ",,__s.'S \0",_ h~"C-. "" O\.LY'" ~pr~ ,'.. d'IPL-t'li DV\. S~() $-\-,1 oVlA OUf [,.,€Lt.:LS..~ -9-"..." ~,'-S (\~ road. A \ ~ n i -\\d't? ,,<; ~o <..ov\.~~ OOrd\ ~ i\. 'D\.C Vle..t'":.<. \..t~ f v.>/ \ ') ~ a. '" J -\-~e f>'" ""r I-e. ; v'\ S').~9 \1t3 \... J31ltt\. \<.s . (ke_ (\e.v)v:,.\-' ~ClI'\P ... d'O~+ h l1<; b.< aY\ aJ.c.h-PJ~5 n( \()2..'1 tJ S'3r-J . SItw Y\ Proposed Address: ~"",,,,,+\"'I..':;\ \...) ,-\ \ .f). ../ Signature: CJ}.11 ')\AP t)~ I \D 0. ".e"")rd. a \('lol/P.' _ ~'2.:-1 N"" ~ \D~ 5~ Date: 4---- 1- -08 f?j Fee: .pi ~ ReceiPt#:.- o~\tus,'t p;~~~ntPa~~c) Reference Numbev \ 1 rj)f}fJ?A CO"lD J Approved _ Denied . If approved. ni.f'Xlress is. \O~C\ 6~rcl s,.y Reviewed By: ~d1 'L." U1\(~ Jt 1~ Date: L\- \D~ ) "'" \' \ Shared Dnve(T) /BUlldmg Fonns! Address Change Request 11-02 doc (B)