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2. Name changes for property registered with the DMV must be changed with the DMV prior to submitting changes to our office. *All fields are required. The only exception is old/new phone number.
3. Account Type (Check all that apply)

   1. Business
   2. Vehicle
   3. Excise
   4. Real Estate
5. Old Information
6. Account Number*
7. Business Name*
9. Last Name*
10. First Name*
11. Street Address*
12. City*
14. State*
15. Zip*
16. Email Address*
17. Phone Number
19. New Information
    Please include all changes
20. Business Name*
21. Last Name*
22. First Name*
24. Street Address*
25. City*
26. State*
27. Zip*
29. Effective Date*
    Effective Date
30. Email*
31. Phone Number
32. Comments
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field