ILSDU LogoChange of Address Form

 

 

 

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

Social Security Number ††††† †- †††††††††† †- ††††††††††††††††† ††††††††††††††††††

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

 

Subscribed and sworn to before me this

†_____________ day of _________, 20____,

____________________________________

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



 

 

Please fax the completed form to (630) 221-2312 or mail to:

Illinois State Disbursement Unit

P.O. Box 5921

Carol Stream, IL† 60197-5921

 

SDU Customer Service Line: (877) 225-7077