MOVING RECORD

Township of Palmer, Pennsylvania

Recording Fee: $1.00

Date:____/_____/_______

List all persons above the age of 14 years who will be moving

1. __________________________________________________________________

2. __________________________________________________________________

3. __________________________________________________________________

4. __________________________________________________________________

Address moving from:

Street address:________________________________________________

Address moving to :

Street address:_______________________________________________

City, State, Zip Code: _______________________________________________

Moving Company: ________________________________________________________

Moving Date ____/______/________

PALMER TOWNSHIP RECYCLING CAN MUST REMAIN WITH PROPERTY

Do you own any other property in Palmer Township? ____ Yes _____ No

If yes, check the appropriate box: ____ Business ____Resident ___ Rental Property

If a business, state business name: ______________________________________

Address for future mail correspondence: ____________________________________

_____________________________________________________________________

All accounts in the following office must be cleared prior to moving:

Palmer Township Sewer Revenue (cashier) _______ (initials of office representative)

Earned Income Tax Office _______ (initials of office representative)

Real Estate Tax Office _______ (initials of office representative)

This completed form will serve as documentation of your move.