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2. 
3. Kaufman County, Texas

   Development Services 9-1-1 Address Application

8. Information gathered is used to help emergency service personnel respond to 9-1-1 calls. This form must be completed for all structures in the unincorporated areas of Kaufman County. Please note that the naming of roads or assignment/reassignment of an address is a ministerial act. Kaufman County, its employees or agents, do not warrant or assure that any road or easement is public or private nor what parties or landowners have a right to use the easement.

10. Please Include with the Application: 

    1) Recorded deed to show property ownership.

    2) General site plan to show the general location of the structure to be addressed and the driveway access from the road to the structure.

    3) If there is a Survey, a copy of that.
    

12. When the address is issued, a fee of $40 per address will need to be paid. You can pay in the office or online.

14. Full Name*
15. Date of Request*
    Date of Request
17. Property Ownership*

    1. I am the owner of the property.
    2. I have INCLUDED documentation from property owner allowing me to apply.
19. Phone Number*
20. Email Address*
22. Mailing Address*
24. City*
25. Zip Code*
29. Property Identification

    Please provide any information that might assist in locating your property. The location of the proposed driveway and existing addresses adjacent to the property are necessary for assigning an address in the correct sequence.

31. Property ID # (from County Appraisal District):*
33. Road where property is accessed*
35. Subdivision Name*
36. Subdivision Phase*
37. Subdivision Lot*
39. Nearest Intersection*
43. Nearest Neighbor Information
45. Name & Address
49. Reason For Address*
    -- Select One --MFG HomeFrame HomeBarn/ShedCommercialOther
51. Explain "Other" Reason for Address*
53. Will you require a Septic?*
    -- Select One --Yes - New SepticNo PlumbingExisting Septic
54. Will you require a Culvert?*
    -- Select One --Yes - New CulvertNo NeedExisting Culvert
56. Please attach the following required documents with your address application
58. Recorded Deed*
60. Site Plan*
62. Survey
64. Additional Document
66. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
68. Electronic Signature*
69. Date Signed*
    Date Signed

71. If you check the box: Receive an email copy of this form. You’ll receive an e-mail from NoReplyCivicPlus.com.

Leave This Blank:


73. 1. Receive an email copy of this form.
74. Email address

    This field is not part of the form submission.

75. Submit

* indicates a required field