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ILLINOIS
STATE DISBURSEMENT UNIT
P.O. Box 5921
Carol Stream, IL 60197-5921
Customer Service: (877) 225-7077



Change of Address Form 


First Name † ††††††††††††† ††††† ††††††††††††††††††††† Last Name ††† ††††††††† ††††† †††††††††††††††††††††

List all docket numbers to which the change of address will apply:

††††††††††††††††††††††† Docket Number††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Issuing County

††† ________________________________†††††††††††††† __________________________________

††† ________________________________†††††††††††††† __________________________________

††† ________________________________†††††††††††††† __________________________________

††† ________________________________†††††††††††††† __________________________________

Old Address

†††††††††††† Street Address†† ________________________________________________________

†††††††††††††††††††††††††††††††††††††† _________________________________________________________††††††††††

††††††††††††††††††††††††††††† City†† ________________________†† State† ___________†† Zip ___________†††††††††††

New Address

†††††††††††† Street Address†† ________________________________________________________

†††††††††††††††††††††††††††††††††††††† _________________________________________________________††††††††††

††††††††††††††††††††††††††††† City†† ________________________†† State† ___________†† Zip ___________†††††††††††

 

Effective Date of Address Change: ______________________________________

Daytime Telephone: ________________ Home Telephone: ___________________

______________________________________________ _____________

Signature (required to validate this request)††††††††††††††††††††††††††††††††††††††††††††† Date

PLEASE NOTE Ė YOU MUST INCLUDE A COPY OF YOUR

DRIVERíS LICENSE OR STATE ID WITH THIS FORM.

(Please check the appropriate box and include the ID)

q     Copy of Driverís License

q     Copy of State ID

If your docket was issued from Cook County and you do not have a child support case with the Department of Healthcare and Family Services,you must have this request notarized.If the form has been notarized please mail to address listed above.

 


Subscribed and sworn to before me this

†_____________ day of _________, 20____,

____________________________________

†††††††††††††††††††††††† Notary Public



 

 

††††††††††††††††††††††Please fax the complete form to (630) 221-2312 or mail to address listed above.

If you would like to receive notifications from the State Disbursement Unit that there has been a disbursement on your child support case listed above, please complete the requested information below.

Mobile phone number: __________________††††††††††††††Email: ________________________________

††† (Standard Text Messaging rates may apply)††††††††††††††††††††††††††††††††††††††††††††††††††††††††(Please print and write clearly)

Preference (Circle One): Text Message ††† Email Message

If both mobile phone number and email address are provided but no preference is indicated the notification method will default to email.