ILLINOIS

STATE DISBURSEMENT UNIT

P.O. Box 5921

Carol Stream, IL 60197-5921

Customer Service: (877) 225-7077

 

NAME CHANGE FORM

 

All name changes are required to submit official documentation of their name change.

A copy of one of the following with the correct name must be faxed or mailed to the Illinois State Disbursement Unit:

 

  • Driverís License
  • Marriage License

 

Effective Date of Change: _________________________________________

 

 

OLD NAME

 

NEW NAME

First Name:

 

 

 

M.I.:

 

 

 

Last Name:

 

 

 

Phone Number:   _________________________________________

 

 

List all the docket numbers to which the name change will apply:

 

Docket Number

 

Issuing County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

________________________________________________†† ______________________

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

 

 

Please fax the completed form to (630) 221-2312 or mail to the Illinois
State Disbursement Unit at the above address.


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.