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2. Laurens County E-911 Address Request Form
4. Before you fill out this form please make sure that your driveway construction is complete and is clearly is marked.

   Driveway construction must be complete and marked with ribbons, flags, etc. 

   This form must be completed entirely for an address to be issued. Please plan for adequate time in your project timeline to provide for address assignment services.

   PLEASE CALL 478-275-7099 WITH ANY QUESTIONS PRIOR TO FILLING OUT THIS FORM 

6. Name*
7. Email Address*
9. Cell Phone Number*
10. Other Contact Number
14. Closest Address*

    Describe the closest 2 addresses to your property. Please specify whether it's on the same side of the road or across the street, etc.  Please provide nearest intersection.

16. Map Parcel*

    Please provide the Map and Parcel Number, These can be acquired by visiting the Laurens County Tax Assessors Website.

    Addresses will remain as "pending" until plat is recorded and Parcel number is provided 

17. GPS Coordinates

    Please provide GPS coordinates if available

19. Laurens County Tax Assessors Website

    Visit here to search for Map and Parcel Number

21. Any Additional Details*

    Please provide us with any other relevant information related to your new address.

25. For 911 Personnel Only
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

* indicates a required field