Randolph County Alabama

New 911 Address Request Form

This is the form to apply for a new 911 address. This is for Randolph County ALABAMA.

Please fill the form out carefully and as accurately as possible.

PLEASE NOTE:

A marker will need to be placed at the road marking where the driveway will begin. It will need to be visible from the main road your address will be assigned from. If your driveway is not marked and your address is not able to be assigned while we are out in the field due to incorrect information provided or no markings then you may have to wait up to a month until our next scheduled addressing date before we can attempt to assign your address again.

Please list in the notes below what kind of marker and any additional helpful information needed to help locate your property.

Applicant Name (who the address will belong to)

Phone Number (We may try to reach you if we have questions.)

Email (this is how you will receive your new address)

List everyone who will be living at this address: (If this is for a business, list the business name.)

What road will your property be addressed off of? (the road your driveway will begin on)

What is your nearest neighbor's address? If unknown, list enough details to help us locate your property.

Parcel Number (can be found on deed or at the tax office.) If unknown put 0.

Type of structure to be placed on property. (Addresses are not assigned to vacant lots that will not be built on.)

If "Type of Structure" was "Other" please list the type here.

Select ALL that apply.

The area is cleared out.

The area is not cleared out.

Driveway is already present.

Driveway is marked but not cut.

Structure will be visible from the road at the end of construction.

Structure will not be visible from the road at the end of construction.

How will your property be marked for us to locate it? Property must be marked.

Upload a picture of your property from the road with the markers included.

I attest that I am the legal owner of this property or have proper documentation from the property's legal owner allowing me to request an address for this property.

I have filled the form out in its entirety and information provided is correct.