E911 Physical Address Request Form

Name(*)

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Email(*)

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Phone Number(*)

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Mailing Address

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City

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State

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Zip

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Select

Person requesting address IS NOT property owner Invalid Input

Name, title and contact information of person requesting address(*)

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Reason for Address Request(*)

Please Explain(*)

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Physical Address Site Identification

Parcel Identification Number (8 digits)(*)

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Street Name Providing Access(*)

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Are there or will there be structures on this property within the next year?

YesNo Invalid Input

Please select which best describes development(*)

Is there LANDLINE telephone service at this property?(*)

Yes

No

I don't know

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Who is the service provider?(*)

ACS

GCI

TelAlaska

MTA

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Please list all landline telephone numbers associated with this property(*)

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Prove you're not a robot.(*)

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A notification letter will be sent to the property owner of record when address is assigned.

Please click the Submit button ONLY ONCE. It can take up to 30 seconds for the form to be submitted.

You will be redirected to the KPB Addressing Home Page once the form has been submitted.

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E911 Physical Address Request Form