Mailing address change form

Here is a sample mailing address change form that you can use as a template:

Mailing Address Change Form

Current Address:

• Name: _____
• Street Address: __
• Apartment/Unit Number: __
• City: __
• State: __
• ZIP Code: __

New Address:

• Name: _____
• Street Address: __
• Apartment/Unit Number: __
• City: __
• State: __
• ZIP Code: __

Effective Date of Change:

• Date: __

Reason for Change:

• (Optional) Please provide a brief explanation for the address change: ___

Signature:

• I hereby certify that the above information is accurate and complete. I understand that any failure to provide accurate and complete information may result in delays or errors in processing my request.

Signature: __ Date: ___

Additional Information:

• If you are changing your address for a business or organization, please provide the following information:
  • Business/Organization Name: __
  • Business/Organization Address: __
  • Business/Organization Contact Person: __
• If you are changing your address for a government agency or public entity, please provide the following information:
  • Agency/Organization Name: __
  • Agency/Organization Address: __
  • Agency/Organization Contact Person: __

Certification:

• I hereby certify that I am authorized to make this address change on behalf of the above-named individual or organization.

Signature: __ Date: ___

You can customize this form to fit your specific needs and requirements. It's a good idea to have the form notarized and to keep a copy for your records.