SERVICE LIST REQUEST / ADDRESS CHANGE FORM
PUBLIC UTILITIES COMMISSION
1150 E. William Street Carson City, NV 89701-3109 Ph: (775) 684-6101 / Fax: (775) 684-6110
OF
NEVADA
9075 W. Diablo Drive, Suite 250 Las Vegas, NV 89148-7674 Ph: (702) 486-7210 / Fax: (702) 486-7206
www.puc.nv.gov
Subscribers to this list will receive notification of all notices and orders specific to a selected open docket before the Commission. INSTRUCTIONS: Please return the completed form by mail or in person to either of the Commission's offices, or by fax to (775) 684-6110, or by email to
[email protected]. Name: Email: Address: City: Please choose all that apply: Add To Service List – Docket Number: State: NV ZIP: Phone: Company: Fax:
12-05003
Remove From Service List – Docket Number: Change Address Other – Please Specify:
Please choose one: Send Notices and Orders by regular mail. Send Notification of Notices and Orders by electronic mail. Please Note: The type of notification you choose will be for all current and future master and docket service lists you are on.
I acknowledge that by placing myself on a service list I am consenting to the public disclosure of my contact information by the Public Utilities Commission of Nevada.
Signature
Date
INTERNAL USE ONLY Change Made By: Date:
Revised April 17, 2012