Request For Name Address Change

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HARRIS COUNTY CHILD SUPPORT
REQUEST FOR NAME/ADDRESS CHANGE
EMAIL:
FAX:
713-755-4359
MAIL TO:
CHRIS DANIEL, DISTRICT CLERK
POST OFFICE BOX 4651
HOUSTON, TEXAS 77210
ATTENTION: CHILD SUPPORT DEPARTMENT
 SUBMIT THIS COMPLETED FORM WITH SIGNATURE
 WHEN UPDATING ADDRESS INFO, SUBMIT COPY OF VALID STATE ISSUED
PHOTO ID (PHOTO, ADDRESS, AND SIGNATURE MUST BE CLEARLY
VISIBLE)
 WHEN UPDATING LAST NAME, SUBMIT MARRIAGE CERTIFICATE COPY
AND COPY OF VALID STATE ISSUED PHOTO (PHOTO, ADDRESS, AND
SIGNATURE MUST BE CLEARLY VISIBLE)
 IF LICENSE OR ID HAS EXPIRED, PROVIDE AN ADDITIONAL VALID FORM OF
ID (e.g. CREDIT CARD, PASSPORT, etc.)
**IF YOU ARE SUBMITTING AN ADDRESS CHANGE TO UPDATE THE
COURTS SYSTEM PER COURT ORDER, PLEASE SUBMIT YOUR UPDATE IN
WRITING DIRECTLY TO THE COURTS.**
CHECK ALL THAT APPLY
___ NAME CHANGE
___ ADDRESS CHANGE
(PLEASE PRINT)
TODAY’S DATE _____________
CAUSE #______________________
YOUR NAME: _______________________________________________
Select One: I am the Payor (make payments) ___ I am the Payee (receive payments) ___
ADDRESS: __________________________________________________
CITY: _____________________ STATE: _____ ZIP CODE:________
CELL: ________________________ HOME:_____________________
E-MAIL ADDRESS: ________________________________________
DRIVER’S LICENSE NO. _______________SSN ________________
SIGNATURE ______________________________________________
If you have any questions regarding this form, please call us at 713-755-7300.
HCCSNAC150824

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