Online Submission
Required Values
Address for Verification:
City, State, & Zip: IN
Business Name of Address for Verification:
Applicant's Name:
Applicant's Address:
Applicant's Phone:
 (   )    - 
Contact Name:
(If different from
Applicant's Name.)
Contact Address:
Contact's Phone:
 (   )    - 
Contact Email:
The County Verification of Business Location Form will be emailed to you. This email address will not be used for any other purpose.
Full payment must accompany this submission. If you do not complete the payment process, this submission will be cancelled.

Please allow up to 5 business days for completion.
I hereby request the Hamilton County Surveyor's Office to complete a County Verification of Business Location, state form 44184 in accordance with Indiana Code 7.1-3-4-3.
Applicant's Typed Signature:
Screen ID: 600982