Free CS05.PDF - Texas

LOREN JACKSON HARRIS COUNTY DISTRICT CLERK
CHILD SUPPORT OFFICE 1115 CONGRESS, ROOM 10 HOUSTON, TEXAS 77002 (713) 755-6077 (713) 755-4359 Fax
(PLEASE PRINT)

NAME/ADDRESS CHANGE FORM

Cause Number ______________________Today's Date ___________________ Payor's Name (Makes Payments) _______________________________________ Payee's Name (Receives Payments) _____________________________________
A state issued photo ID is required before any changes can be made. If license or state ID has expired, please provide us with an additional form of ID, i.e. credit card, passport, etc. In order to eliminate payments returning to this office, please notify the Child Support Office in writing or in person immediately once you have moved.

I have omoved oremarried and would like to change my oaddress oname to: NAME _____________________________________________________ IN CARE OF (C/O) ___________________________________________ STREET ____________________________________________________ CITY ________________________ STATE _________ ZIP ________
HOME PHONE ( ____ ) ____________ BUSINESS PHONE ( ____ ) _____________

E-MAIL ADDRESS ___________________________________________ DRIVER'S LICENSE NO.____________________ SSN ___________________ PAYOR'S SIGNATURE _____________________________________________ PAYEE'S SIGNATURE _____________________________________________
FINCS05 REV 04/07/00