St. Michael Census Update Form

Name Change Information

I want to submit a name change for these people in my family: * No oneHead of householdSpouseChild

Name Change Information - Head of household

Previous full name:

First

Middle

Last

Change name to:

First

Middle

Last

Name Change Information - Spouse

Previous full name:

First

Middle

Last

Change name to:

First

Middle

Last

Name Change Information - Child

Previous full name:

First

Middle

Last

Change name to:

First

Middle

Last

Address Change Information

I want to submit a change of address and/or phone number: yesno

What kind of address change is this? PermanentSeasonalTemporary

Please specify the date range of your temporary address (example: until August 30, 2010)

Please specify the date range of your seasonal address (example: November 15, 2010-May 1, 2011)

New Address

Mailing Name How you would like your mail addressed

Street Address *

Address continued

City *

State *

Zip *

Home Phone Number

*( )

* -

Email Address *