ATCOG 9-1-1 Address Request Form

ATCOG 9-1-1 Address Request Form
If you require accessibility accommodations, please call 1-888-373-9028
Select the structure's driveway location on the map below.
- Click and drag the red pin to the location of the structure's driveway.
- This step must be completed in order for our team to quickly provide an accurate address.
Select Structure Driveway Location (near where the driveway meets the road)*
Tips:
1. When using zoom or pan on the map, the red pin will not automatically move. You must manually drag the pin so that it is within the map window.
2. To view satellite imagery, select the "Satellite" button in the top left corner of the map.
3. Use the scroll wheel on your mouse to zoom or use the + and - buttons on the lower right corner of the map. On a mobile device, you may also use the pinch-to-zoom gesture.
4. The map will automatically pan when the red pin is dragged near the edge of the visible map.
Driveway location must be selected before continuing.
Your Name*

TitleFirst NameLast Name
Requestor Organization (if you are a representative of a corporation, agency, developer, etc.)
Organization Name (Optional)
Is the structure a residence?*

YesNo
Resident Name (if different than your name)

TitleFirst NameLast Name
Phone Number*
Enter your phone number.
Phone Number Type
Secondary Phone Number
If desired, enter a secondary phone number. (Optional)
Phone Number Type
Email*

Confirmation EmailPlease enter your email address. You will receive a confirmation message at this email address.
County*
Please select the county of the structure. If your county is not listed, contact the 9-1-1 addressing authority for your county.
Type of Request*

New StructureExisting StructureOther
Is this request for a cell site, cell tower, or similar telecommunications structure?*

YesNo
If you have a site plan or similar document upload it here. (OPTIONAL)

Acceptable file types include: .PDF, .DOC, .DOCX, .XLS, .XLSX, .JPEG, .PNG, .TIFF, .DWG, .DXF, and .DGN
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Are you a property developer, land developer, real estate agent (or acting on behalf of one) and requesting one or more addresses within the same development?*

YesNo
If you have a plat, site plan, or similar document upload it here. (OPTIONAL)

Acceptable file types include: .PDF, .DOC, .DOCX, .XLS, .XLSX, .JPEG, .PNG, .TIFF, .DWG, .DXF, and .DGN
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Is this request for a single address located within a subdivision, mobile home/RV park, apartment/condominium building, or multi-tenant structure?*

YesNoUnsure
Development Location Information

Please enter information if structure is located in a subdivision, mobile home/RV park, apartment/condominium, or multi-tenant structure.
Name of Subdivision, Mobile Home/RV Park, Apartment/Condominium, or Multi-Tenant Structure
Please enter location name. (Optional)
Lot Number
Please enter lot number. (Optional)
Block, Tract, and/or Phase Number
Please enter block, tract, and/or phase number. (Optional)
Other Identifying Number or Name
Please enter any other identifying number or name. (Optional)
Structure Information
Type of Structure*
Please select the closest matching type of structure.
Road Name*
Please enter the road name for the new structure. (This should be the street where the driveway will be located).
Cross Street Name (if applicable)
Please enter the closest cross street for the new structure. (If applicable)
Location Information for New Structures*
Previous/Existing Structure Address (if known)

Street Address

Street Address Line 2 (apartment, building, suite, unit, etc.)

City or MunicipalityState

Post Code / ZIP Code
Previous Resident or Tenant Name (if known)
Please enter the name of the previous resident or tenant.
Location Information for Existing Structures*
Parcel ID
Please enter the appraisal district parcel ID.
Other Request*
Please provide a detailed description of the request.
(OPTIONAL) Comments, Information, or Other Details
If needed, enter any other comments or information. (Optional)
(OPTIONAL) If there are any images or documents that will assist in identifying your address request location, please upload them below. NOTE: Don't include any confidential or private information.

Acceptable file types include: JPEG, PNG, TIFF, and PDF.
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Please verify that you are human:*
All form data and information is submitted using 256 bit SSL (Secure Socket Layer) connection that uses a SHA256 Certificate.
Ark-Tex Council of Governments
PO Box 5307, Texarkana TX, 75505-5307
1-888-373-9028

Copyright © 2024 Ark-Tex Council of Governments, All rights reserved.
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ATCOG 9-1-1 Address Request Form

Driveway location must be selected before continuing.

Development Location Information

Structure Information