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2. Name of Municipality, Sanitary District, or Public Hospital*
   -- Select One --Bald Head IslandBelvilleBoiling Spring LakesBoliviaCalabashCarolina ShoresCaswell BeachHolden BeachLelandNavassaNorthwestSouthportOak IslandOcean Isle BeachSandy CreekShallotteSt. JamesSunset BeachVarnamtownH2GO Brunswick Regional Water & SewerSoutheast Brunswick Sanitary DistrictDosher Hospital Board of Trustees
4. Name of Elected Official*
6. Office/Position Held*
   -- Select One --AldermanCommissionerCouncil MemberMayorTrustee
8. Type of Change*
   -- Select One --Appointment to Fill VacancyDeathRemovalResignationRetirementOther (explain below)
10. If Other, please specify:
12. Effective Date of Change*
    Effective Date of Change
14. Name of New Official (if applicable)
16. Upload Supporting Documents

    (e.g., council resolution, resignation letter, meeting minutes)

18. Submitted By*
20. Submitter Email Address*
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

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