Randolph County Assessor's Office
			Change of Address Form
Old Information on current tax bill
Name:_______________________________					Acct#_____________		District____________
Address:_____________________________					Map______________		Parcel_____________
____________________________________					Acct#_____________		Parcel_____________
Phone:______________________________					Map______________		Parcel_____________
					Acct#_____________		District____________
New Information:______________________					Map______________		Parcel_____________
Name:_______________________________
Address:_____________________________					Deputy Who Made Change:
____________________________________					____________________________________
Phone:_______________________________
					Other Important Information:
					____________________________________
I certify that I am the owner of this property or have the legal power of attorney of the owner to
request the tax bill address change.
Signature_______________________________________________						Date:______________________