Bradley County Arkansas

Application for Address

To apply for a 9-1-1 address for your new home, business, or other structure, please fill out this form and click Submit.

Within ten (10) working days after you submit your form, you will receive notice of your assigned address by telephone. A follow-up confirmation letter will be mailed to you at the current mailing address you provided on this form.

IMPORTANT NOTES:

A 9-1-1 address for a new structure should be obtained before making arrangements for utility services. Utility companies (telephone, electric, gas, water, and so forth) will request a 9-1-1 address for structures to be served.

If you are not sure if you need a 9-1-1 address, check with the 9-1-1 Coordinator to make sure. Most structures will require an address if utilities are needed. An address is required: any time a new residence (of any kind) is to be built; when a mobile home is to be moved or setup on your property, or when any residential or business structure is moved. ALWAYS CHECK TO BE SURE IF YOU NEED A NEW ADDRESS OR TO CONFIRM AN ADDRESS.

Request for 911 address

* Required fields

* Applicant Name

Daytime Phone

Evening Phone

* Phone number to call to provide your assigned address

* Email Address

* Current mailing address

* City

* State

* Zip code

Property owner (if different than above)

If an existing structure/mobile home, who was the previous owner or resident (if known)?

If an existing structure/mobile home, about how old is the home/building?

* Property's access road/street name (example Bradley 16)

If property will share an existing driveway, address of shared driveway

Neighbor Information

To help us locate and address your new structure, please provide the name(s) of your nearest neighbor(s) and address(es), if known. These should be based on facing your structure from the road.

Neighbor's Name

911 Address

Facing your property, the neighbor is to the
Left
Right
Across road

Neighbor's Name

911 Address

Facing your property, the neighbor is to the
Left
Right
Across road

Neighbor's Name

911 Address

Facing your property, the neighbor is to the
Left
Right
Across road

Neighbor's Name

911 Address

Facing your property, the neighbor is to the
Left
Right
Across road

Structure Information

Is the structure a (check one)
Single family house
Duplex
Apartment (If apartment, number of units)
Mobile home
Business
Other (Please specify)

Is the structure visible from the road
Yes
No

Is the structure under construction
Yes
No

If yes, enter the color of stake flags


Construction fully completed
Yes
No

Color of outside walls

What are outside walls constructed of (brick, wood, rock, vinyl)?


Is this a mobile home?
Yes
No

Please provide additional information that will help us locate the structure to be addressed. Please be as descriptive as possible. Include distance from the closest intersecting road/street and directions to the structure. You may send a drawing or map if it will help explain the exact location.

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