677 Leonard LaCities Diaital Qualitv Co
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city oF eegan
PAT GPAGAN
Mayac
PEGUY CARLSON
CYNDEF. PIF],DS
MIKE MAGUIRE
MEG TILLEY
CouociL Membecs
THOMAS HBDGLS
Ciry Admmisnami
Mmucipal Center
3830 Pilot ICnob Road
Eagan, MN 55122-1897
Phone65LC7j.5000
FaY- 651.6755012
TDD. 651.45h.8535
Maincenance Facility:
3501 Coachman Poinc
Eagan, MN 55122
Phane: 651-675 5300
Fax: 651.675.5360
'f DD: 651.454.8535
www.dtyofeagarv.com
THF. 1 ONE OAK TRiF,
Thc rvm6ol of scicngch
and gimvth m nm
coinmuniry
ADDRESS CHANGE REQUEST
DATE: !- -;Z7- 0-?' FEE: $50.00
EXISTING ADDRESS: L-77 Le oh Z r" J- La n?--
NEW ADDRESS: 39 (d 7 A(' len s c?
LOT )l BLOCK ?
PLAT NAME ?L (- 'r a
REASON:
ra?-?-o?- y- e ? ij. e 5 4-
PRINT APPLTCANT NAME
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SIGNATURE
CD/FORMS/CHANGE OF A?D[2ESS