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Request for Civic Address 911 Number

Property Owner Last Name

Property Owner First Name

Please enter your mailing address

Please enter an email address

Please enter your primary phone number

Please enter the name of the previous property owner, if property purchased within the last six months.

Please choose the road name the property is on if known

Is this property the result of a severance? Please answer this question to the best of you knowledge.

Yes

Roll number of the property 4402 _ _ _-_ _ _-_ _ _ _

The undersigned acknowledges that he/she/it/they (and not the Town) is/are soley responsible for any and all costs, including any Town fees and charges, associated with the requesting the municipal address of the property.

Clear

Date of SIgnature

Personal information on this form is collected pursuant to the Municipal Act, 2001 and in accordance with the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpoes of processing this request and updating Town records.

Please note that an Entrance Permit is required from the Town of Gravenhurst Infrastructure Department for all access driveways off municipal roads.

Property owners requiring access off a Muskoka Road must obtain an Entrance Permit from the District of Muskoka.

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Request for Civic Address 911 Number

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