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The Phoenix City Council voted on Nov. 18 (City of Phoenix)

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Street Renaming Reimbursement Form Log #: ___________
Staff use only
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 Nov. 18 to rename your street. 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 driver’s 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.
✓ FOR REPLACEMENT OF PRE-ADDRESSED DOCUMENTS please include a copy of the document
being replaced. Please cross out or mark over any confidential information.
SUBMITTAL INSTRUCTIONS
Please print out this filled form and mail it along with receipts and copies of updated documents to:
1. By Mail
Phoenix Planning and Development Department
Attn: STREET RENAMING
Phoenix City Hall
200 W. Washington St.
Phoenix, AZ 85003
Reimbursement requests will be processed with a payment issued within 14 calendar days of receipt.
Street Renaming Reimbursement Form Log #: ___________
Staff use only
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: __________________
Applicant’s SSN or EIN: _________________________________________________________
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: ___________
SSN/EIN TIN Match Completed By: __________________ Reviewed/Approved By: _________________
SAP Document#: ____________________________________
Phoenix
AZ
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The Phoenix City Council voted on Nov. 18 (City of Phoenix)

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Completed 12 February 2021

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