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 Service.List@puc.nv.gov. 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.

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Revised April 17, 2012