Instructions for Using Notification of Name/Address Change The Notification of Name/Address Change form is designed for custodial and non-custodial parents who would like to change their name or address of record with the Clerks office. 1.) Print or type all information on the form. 2.) Sign and date the form. 3.) Custodial parents mu have this formst notarized. 4.) Submit completed forms to: Clerk of Circuit Court Attention: Child Support Division P.O. Box 104 DeLand, FL 32721 Once this form is received by the Clerks office your nam and/or address will be updated in our database and ethis form will be filed in your permanent file in the Family Law Division. >>>> 2 DIANE M. MATOUSEK CLERK OF THE CIRCUIT COURT SEVENTH JUDICIAL CIRCUIT VOLUSIA COUNTY, FLORIDA PLEASE REPLY TO: Child Support P.O. Box 104, DeLand, Fl 32721-0104 NOTIFICATION OF NAME/ADDRESS CHANGE CASE NO. DATE: Plaintiff/Petitioner/Payee Defendant/Respondent/Payor OLD Name/Address: S treet City State Zip Code NEW Name/Address: Street City State Zip Code Signature Phone Number The foregoing instrument was acknowledged before me this Witness my hand in Volusia County, ________ day of ______________________, ___________ State of Florida, this day of by______________________________________ Who is , . Personally known to me or has produced________________ _________________________________as identification. DIANE M. MATOUSEK CLERK OF THE CIRCUIT COURT Notary Public____________________________________ Print Name By: Commission #____________________________________ Deputy Clerk CL-0368-0003 Address Changed On Court Manageme nt (For Clerks Use Only)