Owner Name Mailing Address Change Form
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1City of Chicago
Department of Finance
Water Billing & Collections
333 S. State St, Suite 330
Chicago, Illinois 60604
Owner Name/Mailing Address Change Form
Account Number
*
:
____________
_____________
Customer Code
Premise Code
*Premises Address: _________________________________________________
*Current Owner Name: _____________________________________________________
(as currently listed on bill)
Last
First
* Property Index Number: _____ - _____ - _______ - _______ - __________
(Found on Property Tax Bill)
*Phone Number:
_______________________ Email Address: _____________________
If requesting to change Mailing Address, please complete this section:
Mailing Address:
____________________________________________________________
Number
Dir
Street
Suite #/Floor
__________________________________________________________________________________________
City
State
Zip Code
__________________________________________________________________________________________
Attention Name
If requesting to change owner name, please complete this section:
*New Owner Name: ________________________________________________________
Last
First
*Date of Purchase/Closing: ______________________
*Was a Full Payment Certificate obtained Yes/No? _______________
Please note: If the Department does not have a record of the Full Payment Certificate from your closing, you may
be required to provide us with a copy of the deed, closing statement and/ or full payment certificate.
The undersigned Applicant on oath deposes and says that (s)he is responsible for water bills for above
premise and that (s)he is subject to penalties for perjury for falsification herein.
Print Name: __________________________________________________________________
Signature: _______________________________ Date: ______________________________
*Required Field
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Parent category: Legal