E911 Physical Address Request Form

Name(*)

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Email(*)

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Phone Number(*)

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Mailing Address

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City

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State

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Zip

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Select

Person requesting address IS NOT property owner Invalid Input

Name, title and contact information of person requesting address(*)

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Reason for Address Request(*)

Please Explain(*)

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Physical Address Site Identification

Parcel Identification Number (8 digits)(*)

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Street Name Providing Access(*)

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Are there or will there be structures on this property within the next year?

YesNo Invalid Input

Please select which best describes development(*)

Is there LANDLINE telephone service at this property?(*)

Yes

No

I don't know

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Who is the service provider?(*)

ACS

GCI

TelAlaska

MTA

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Please list all landline telephone numbers associated with this property(*)

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A notification letter will be sent to the property owner of record when address is assigned.