City of Bloomington Utilities

Request for Individual Name Change

Name change request form. You will need a substantiating document (marriage license, divorce decree, etc.) to attach as a file to this form.

Customer Service Office Contact Information

Operating Hours	8:00 am to 5:00 pm M-F
Address	600 E Miller Dr Bloomington IN 47401
Phone Number	(812) 349-3930
Email Address	utilities.cs@bloomington.in.gov

* Field is Required

First Name *

Middle Name

Last Name *

Former Last Name *

Telephone Number *

Email Address
(Please provide an email address to receive a confirmation email and status updates)

The service address is:

St Num *

St Dir.

Street Name/Unit *

City of Bloomington Utilities Account Number *

Please include either a photcopy of your driver's license, a marriage license, or a divorce decree. If you send a driver's license, please make sure it shows the new name change.