Application for an official address

Surname, first name:

Street, house number:

ZIP code, city:

Phone:

E-Mail:

I hereby apply for the following property to be issued with a notice of determination of the official residential address / business address

District:

Hallway:

Parcel:

Location name / street:

Subject of the application (single-family house, multi-family house, semi-detached house, residential building, garden plot, commercial property, etc.)

Number of building entrances:

This is a:

Old building

New building

Cultivation

Notes

To ensure that the building can be correctly assigned to the street, it is absolutely necessary to enclose a site plan with the house entrance marked!
The issue of a house number does not automatically give rise to a legal entitlement to obtain permits, approvals or authorizations based on other legal provisions, in particular the Building Code.
Fees are charged for the issuance of the notice to issue a house number in accordance with the administrative cost statutes of the City of Jena dated 14.03.2018

Date of application

Signature of the applicant