Mailing Address Change Request - Township of Puslinch

Owner Information

Name *

First

Last

I am the property owner *

Yes
No

Roll Number (ie. 23-01-000…) *

Property Location

Current Mailing Address *

Address Line 1

Address Line 2

City

Province

Postal Code

New Mailing Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Effective Date of Change

Email Address *

Telephone Number *

Do you authorize the Township of Puslinch to share your updated mailing address with MPAC? *

Yes
No

Signature *

Clear Signature

Freedom of Information Disclaimer

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of processing this request and is maintained in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Questions regarding the collection of this information may be directed to the Township Clerk’s office.

The Township of Puslinch is committed to providing accessible formats and communication supports for people with a disability. If another format would work better for you, please contact the Township Clerk’s office for assistance.