Community Development Department Use ONLY:
Reviewed by: ______________________________ Date: ____________
Approved by: ______________________________ Date: ____________
10/2020
Organization Change of Address Form
Grant Type: ___________________________
Organization Name: ______________________________________________________
New Physical Address: ______________________________________________________
Date of move-in: ______________________________________________________
Mailing Address: ______________________________________________________
Phone Number: ______________________________________________________
Email Address: ______________________________________________________
Previous Address: ________________________________________________________
Brief description of the reason for move:
________________________________________________________________________
________________________________________________________________________
Are there personnel changes taking place with this move? Yes No
(If yes, a personnel change form must be submitted and attached to this move form)
___________________________ ___________________________
Signature of Authorized Official Date
________________________________________
Print Name & Title of Authorized Official
If your organization’s physical or mailing address changes please update this form and mail it to
the address listed below, within 10 days. Failure to do so may result in suspension of your
grant allocation.
Community Development Department
1149 Ellsworth Drive
Pasadena, Texas 77506
