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COP PDD Logo
Payment Log #: __________
Staff use only
Street Renaming Reimbursement Request
For more information or for a copy of this publication in an alternate format, contact Planning &
Development at (602) 262-7811 / (602) 534-5500 TTY.
Page 1 of 2
PROGRAM INFORMATION
The Phoenix City Council voted on _________ to rename _______________________. As part
of the street renaming process, the City of Phoenix will reimburse costs incurred by residents
and businessowners to update their addresses. The reimbursement program covers expenses
such as drivers license updates, mailing information changes, and other related costs to update
personal or business documents.
STREET RENAMING REIMBURSEMENT APPLICATION CHECKLIST
When applying for reimbursement of costs related to a street renaming project, please submit
a complete application packet.
Use this checklist to help you gather what you need to apply for reimbursement.
☐COMPLETE THE APPLICATION
Ensure that the Project Location identifies the correct Street Renaming project for
which you have incurred costs.
Complete the Application Information section in its entirety. If the address of your
property is not the same as your mailing address, please fill out the mailing address
portion.
Provide complete information regarding the Expenses Requested for
Reimbursement.
☐PROVIDE EXPENSE DOCUMENTATION AND RECEIPTS
Gather receipts or payment confirmation documentation for expenses incurred for
address changes.
Ensure receipts are legible and reflect the company and amount paid.
SUBMITTAL INSTRUCTIONS
You may submit your application three different ways:
1.
By Mail
Planning and Development Department
Phoenix City Hall
200 W. Washington St.
Phoenix, AZ 85003
2.
By Email
Send your application in a PDF format to XXX@phoenix.gov with the subject line,
“Street Renaming Reimbursement Request”.
3.
In Person
Reimbursement requests will be processed with a payment issued within 21 calendar days, of
application approval.
ATTACHMENT F
COP PDD Logo
Payment Log #: __________
Staff use only
Street Renaming Reimbursement Request
For more information or for a copy of this publication in an alternate format, contact Planning &
Development at (602) 262-7811 / (602) 534-5500 TTY.
Page 2 of 2
APPLICATION FORM
A. Applicant Information
Applicant: __________________________________________ Phone: __________________
Property Address: _____________________________________________________________
City: ______________________________ State: ________ Zip Code: _________________
Mailing Address (if different): _____________________________________________________
City: _________________________________ State: _____ Zip Code: _________________
Email Address: _______________________________________________________________
B. Expenses Requested for Reimbursement
Attach copies of receipts, payment confirmation notifications, or other verifying documentation.
Amount
Company
Address
City
State
Zip
1
$
2
$
3
$
Total Amount Requested: $_________________
I hereby request a reimbursement of the costs and expenses relating to the City of Phoenix
Street Renaming process for the street noted above.
________________________________________ __________________________________
Signature of Applicant
Date
----------------------------------------------------Staff Use Only-------------------------------------------------------
Application received and logged By: _____________ Date: ___________
Approved/Disapproved
By: _____________ Date: ___________
Payment Issued
By: _____________ Date: ___________
Vendor #_______________________
SAP Document #: _________________________