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2. First Name*
3. Last Name*
4. Property Location*
   -- Select One --Bath TownshipBeavercreek TownshipBellbrook CityBowersville VillageCaesarscreek TownshipCedarville TownshipJamestown VillageJefferson TownshipMiami TownshipNew Jasper TownshipRoss TownshipSilvercreek TownshipSpring Valley TownshipSugarcreek TownshipXenia Township
6. E-Mail Address*
7. Phone Number*
8. Parcel Number
   Provide Parcel ID - If Known (i.e. B03000100010000100)
10. What type of address is being requested?*

    1. Primary
    2. Secondary
    3. New Develpoment (Platted Lots)
11. Structure Type*
    -- Select One --RESIDENTIAL HOUSINGDUPLEXTRAILERSECONDARY STRUCTUREUTILITYADDRESS W/O A STRUCTURESINGLE APARTMENTMULTI UNIT APARTMENT W/UNIQUE SUFFIXCOMMERCIALCAMPGROUNDS
13. Has the plat record been recorded with the Greene County Recorder's Office?

    1. Yes
    2. No

    Note: Plats that have not been recorded and do not currently have an address assigned to the parcel(s) can be assigned a construction address only. This address can stay with the plat following the building process.

15. Description & Comments*

    Please provide any additional information for the address request.

17. Upload

    Upload any documents that show future building plans if necessary.

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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field