9-1-1 A Master Street Addressing Guide (MSAG) Request Form

Use this form to request changes to the MSAG, such as:

Correction of an invalid street name
Correction on an invalid address range
Addition of new addresses such as a new subdivision or street
Deletion of addresses that have annexed into another jurisdiction or duplicate entries
Changes to Emergency Service Number (ESN) assignments due to a new fire station or police district.

Important! When filling out this form, please use 'tab' to move to the next box and 'shift+tab' to move back. Don't press enter until you are ready to submit the form. If you accidentally submit a partially completed form, please notify Kathy Bover.

Type of Request:

Jurisdiction:

Addressing Coordinator Name:

Telephone Number
(with area code):

E-mail:

EXISTING MSAG

To delete, modify, split or combine an existing MSAG address, complete the following information.
(To insert new MSAG addresses, see below.)

Directional
(Please choose one):

(Only one directional choice per form is permitted. For example, if your jurisdiction is making changes to N. Main Street and S. Main Street, a separate 9-1-1A Form must be filled out for each.)

Street Name:

Suffix:

(Use national standard suffixes.)

Community:

(Use the name of the city or town the address is in. If the address is not in a community, enter "Unincorporated _______ County.")

Up to four address ranges can be entered on this form:

	Low Number	High Number	Odd/Even/Both	Emergency Service Number	Telephone Exchange
1.
2.
3.
4.

NEW OR CORRECTED MSAG

To insert a new MSAG, complete the following information.