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2. 
3. City of Laconia, NH
   Department of Assessing
4. NOTE THAT QUESTIONS FOLLOWED BY AN ASTERISK* REQUIRE AN ANSWER IN ORDER TO SUBMIT YOUR REQUEST
6. Owner's Name*
7. Date*
9. Number of properties needing a mailing address change?
10. Email Address*
12. Physical Address of Laconia property 1
13. Physical Address of Laconia property 2
15. Physical Address of Laconia property 3
16. Physical Address of Laconia property 4
18. Physical Address of Laconia property 5
19. Physical Address of Laconia property 6
21. New Mailing Address*
23. City*
24. State*
25. Zip Code*
27. This is a permanent change?*
    -- Select One --YesNo
28. If Temporary, Start Date
29. End Date
31. Additional notes or information
33. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
35. Electronic Signature
37. MAP__________BLOCK_________LOT_________
    For internal use only
38. ADDRESS UPDATED
    For internal use only
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field