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2. Code*

   *The submission code is the 12-character combination of letters and numbers located beneath the barcode in the top right-hand corner of the Town of Falmouth Street List form.

4. Any changes from last year?*

   1. None

   Any changes from last year? If not, you may use this form. If there are any changes, you’ll need to make those changes on your paper street list/census form that was mailed to you and return it to the Town Clerk’s office.

6. Address (Street Number)*
8. Address ( Street Name)**
12. Date**
    Date*
14. Electronically signed by:
16. First Name*
17. Last Name*
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field