Free CJA Registration - Florida

United States District Court Middle District of Florida CJA PAYEE REGISTRATION AND CHANGE OF ADDRESS New attorney NAME: SOCIAL SECURITY NUMBER:
REQUIRED FIELD

Change of Address

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MAILING ADDRESS:

TELEPHONE: FAX NUMBER: E-MAIL ADDRESS:

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@

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Indicate below how payments should be reported to the IRS: Under my SSN and name, as indicated above. ­ OR ­ To the firm with which I am affiliated. The firm's taxpayer identification number, name and address are: Taxpayer ID No. of Firm: Firm Name: Firm Address: (If different from above)
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Payee Signature: Please return this form to: Joan Calcutt CJA Deputy Clerk for the Middle District of Florida FAX: 407-835-4228

Date:

(mm/dd/yy)

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