2007, 09-26 Change of AddressU 71 2-S D3 SITUS ADDRESS CHANGE AUTHORIZATION FORM
PARCEL NUMBER %iiiii SPOKANE ASSESSOR'S
}COUNTY A'S OFFICE
r /(J REQUESTED BY: ,J , Iaa
(Please Print) First J Middle
OWNER NAME: V i 1<ri 0 ,(\CI `��t�UVC \'"l Q�
DATE OF REQUEST: CI Cl) JC)7 REQUESTER'S PHONE NUMBER: ( ) GW--- 6 4
PLEASE PROVIDE DE1SCRIPTION OF REAL PROPERTY ON REVERSE SIDE
OLD SITUS ADDRESS: L' \XY1V IPA InU Lon
NEW SITUS ADDRESS: / UW i l x tk I / X E 1d _
( CC\f''''')
AUTHORIZING SIGNATURE:
OFFICIAL USE ONLY
BUILDING / PLANNING APPROVAL: ASSESSOR OFFICE INITIALS: