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2. I am the property owner or authorized agent as indicated below regarding the following real estate record(s):
4. Property Street Address(es)*

   If more than 1 address, please list in numerical order. 

5. Parcel Number(s)*

   If more than 1 parcel number, please list in numerical order and match the number with the address number. 

7. I am requesting the Auditor of Jefferson County to change the mailing address of the properties listed above to:
9. Name*
10. Phone Number:*
12. Street Address*
14. City*
15. State*
16. Zip Code*
18. Is this mailing address your primary residence?

    1. Yes
    2. No
20. By entering your name in the space below, you are conveying your intent to have the property tax bill(s) for the listed properties only sent to the requested mailing address per IC 6-1.1-22-8.1. Additionally, per IC 26-2-8-102, entering your name in the space below executes your intent to complete and sign the form electronically. Anyone submitting false information on this form is subject to prosecution.
22. Electronic Signature*
24. FAILURE TO RECEIVE A TAX STATEMENT DOES NOT RELIEVE THE TAX PAYER OF THE RESPONSIBILITY FOR PAYMENT AND PENALTIES WHEN DELINQUENT.
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field