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2. Notice
   Do not include any sensitive information on this form or (if applicable) files uploaded to this form. Sensitive information includes, but is not limited to, social security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, or passwords.
4. Utilize this form to submit a name and/or address change request to the Berrien County Treasurer's Office.
6. Property Number*
8. Property Address*
10. City*
11. State*
12. Zip Code*
16. Last Name*
17. First Name*
18. Middle Initial*
20. Spouse/Additional Names
22. Mailing Address*
24. City*
25. State*
26. Zip Code*
28. Reason for change:*
30. Date*
31. Requested By*
Leave This Blank:


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

    This field is not part of the form submission.

35. Submit

* indicates a required field