2. Change of Address Form - Tax Roll
   This form is to be used if you require a change of address.
4. Suffolk County Tax Map Number*
   Example - 100.-5-5.36
5. Date*
   Date
7. Property Location*

   (Street Number, Street Name and Hamlet)

8. Is this your primary residence? *

   1. Yes
   2. No
10. Owner Name*
11. Operating Agreement

    If your property is owned by an LLC or a Corporation upload a copy of the Operating Agreement as a .pdf.

13. Mailing Address Line 1*
15. Mailing Address Line 2
17. City*
18. State*
19. Zip*
21. Email Address*
22. Phone Number
24. Previous Mailing Address
26. Additional Information (Notes)
28. Full Name of Requestor*
    By entering your name in the space above you certify that the information provided on this form is correct.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field