Request for Address Change

I am applying as an:*

Applicant Information

First Name:*

Last Name:*

Mailing Address:*

City:*

Province:*

Postal Code:*

Email:*

Phone Number:*

Owner Information

Are there multiple owners?

Owner Authorization:*

Upload Owner Authorization.*
A letter from the property owner(s) authorizing the agent to act on their behalf is required. It must be signed by the property owner(s).
(PDF format, maximum file size of 3.0MB)

Owner

First Name:*

Last Name:*

Mailing Address:*

City:*

Province:*

Postal Code:*

Email:*

Phone Number:*

Joint Owner

First Name:*

Last Name:*

Email:*

Phone Number:*

Description of Property

Civic Address:*
If no Civic Address, please include the Parcel Identifier (PID) located on the Certificate of Title.

City:*

Province:*

Postal Code:*

Legal Description:*

Application Information

Civic Address Requested:*

Reason for Requesting Addressing:*
Information we collect and why we collect it.

The City of Courtenay is collecting personal information in accordance with Section 26 (c) of the Freedom of Information and Protection of Privacy Act. The personal information collected in this form (name, contact information, etc.) will be used for the purposes of analyzing your responses and administering the Request for Address Change. Questions about the collection, use, and disclosure of this information can be directed to the City’s Privacy Officer at City Hall, 830 Cliffe Avenue Courtenay, BC V9N 2J7. Phone: 250-334-4441 email: info@courtenay.ca



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