IN THE COURT OF COMMON PLEAS
DIVISION OF DOMESTIC RELATIONS
LAKE COUNTY, OHIO
____________________________________
Plaintiff
vs.
Case No. _________________________
_____________________________________
Defendant
CHANGE OF ADDRESS FORM
Today’s Date: _______________________ Effective Date of Change: _____________________
Your Name ____________________________________________________________________
First
Middle
Last
Other Party ____________________________________________________________________
First
Middle
Last
The following information pertains to:
Your Name ____________________________________________________________________
First
Middle
Last
Old Mailing Address: ____________________________________________________________
Number and Street
Unit or Apt. No.
____________________________________________________________
City
State
ZIP Code
New Mailing Address: ___________________________________________________________
Number and Street
Unit or Apt. No.
____________________________________________________________
City
State
ZIP Code
Residence Address: ______________________________________________________________
Number and Street
Unit or Apt. No.
______________________________________________________________
City
State
ZIP Code
I understand that I have a continuing statutory obligation to inform the Court of any changes
in my residence and/or mailing address hereafter.
_____________________________________________
Signature
Date
cc: CSEA
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