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 – YOU MUST INCLUDE A COPY OF YOUR

DRIVER’S LICENSE OR STATE ID WITH THIS FORM.

(Please check the appropriate box and include the ID)

q Copy of Driver’s 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.