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Addressing Miscellaneous 1997-1-13
. .. . .' ADDRESS CHANGE REQUEST ,Property Owner: x;\1. fuJ\L ~ ~f) Hailing Address: ~~~ \<\l HI \)lImO) ~ City: <(,'n~f\<L..- State: OR- Person or Agency requesting change if other than owner: Zip': qltOX (OJ , Jh~__ Phone number where you can be contacted LloC. ":2.\1 Lo ~ ' between 1:00 p.m. and 5:00 p.m.: '\t\~ LJ Address of property you are requesting to be changed: \D~fl ~\. ~("'f::f'~ '. , Assessor HapD ,\'1 D3Q.:)::\.4 . Tax Lot D o e=Arn Please explain speci'fically why you feel the address needs to be changed: :l\..u. ~~ ~\"""'_--... .:~ r..~ .-l.Q_,\ ~\. 1,,,_~._ Co. -, "-D-- ~ ~~,(> ~- ~ ~ .IN/'''''.. ~Q..JI~.~.~_* IW.i.. ~ ~ ~ ~_9.:~ 0Vv ~ ~'t- ~~ ~~r- ~~"^-.~ ~~~~ ~W)\~ Proposed Add ress: Of\.\. 0 \;'\\~.x 01[\7-\ 0 J e 11 0 l'\-\:; ~ l "12.- Sign~ture: ~1 ' " ')--- Date: I z.-/s[ J1L. , ----________LJ____~----------------------------__________:___~____________ Office Use \~ty~~-zM . Jax Lot: 05Qrn Approved / Denied \ \1"\ _ \ If approved, ne.... ,address is: C\A.lo ~~J(Qn11J, Vw Ii t ~ Revie....ed By:ll[)(\) \ _~~ . Date: t 'l~ ,ql) . ~ ~~Q~,~CW.) ~~~w)?.e Reference Number: