SANGAMON COUNTY SUPERVISOR OF ASSESSMENTS SANGAMON COUNTY COMPLEX ROOM 210 200 S. 9TH STREET SPRINGFIELD, IL 62701 TELEPHONE 217/753-6805     FAX 217/535-3143

IT  IS  THE CURRENT POLICY OF THE SUPERVISOR OF ASSESSMENTS TO HAVE THE 
HOMEOWNER'S SIGNATURE ON FILE WHEN REQUESTING THEIR TAX BILL BE SENT TO 
ANOTHER ADDRESS.

DATE:     _____________________________
TAX ID #:
(INDEX #) _____________________________   _____________________________

          _____________________________   _____________________________

          _____________________________   _____________________________

          _____________________________   _____________________________

          _____________________________   _____________________________

I WOULD LIKE MY TAX BILL(S) SENT TO THE FOLLOWING ADDRESS:

NAME:         _________________________________________________
 
              _________________________________________________
	
ADDRESS:      _________________________________________________

              _________________________________________________

              _________________________________________________

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CUSTOMER SIGNATURE:  ______________________________________

CUSTOMER SIGNATURE:  ______________________________________

DAYTIME PHONE:       ______________________________________

COMPLETED BY:  ____________    MORTGAGE CODE:  ____________
                               (IF APPLICABLE)

PLEASE  BE  ADVISED  THAT  IF REQUEST IS MADE FOR A CHANGE OF NAME, THE 
PROPER DOCUMENTS CONVEYING OWNERSHIP  MUST BE  SUBMITTED,  i.e. COPY OF 
DEED, WILL, OR OTHER LEGAL DOCUMENT CONVEYING RIGHTS TO PROPERTY.

THANK YOU.