Circuit Court for City or County Name Name Case No. vs. Street Address Apt # PO Box Street Address Apt # PO Box ( City State Zip Code Area Code ) Telephone City State Zip Code ( Area Code ) Telephone Plaintiff Defendant ADDRESS CHANGE REQUEST Name: Civil Domestic Criminal Trial/Hearing Date: Please update the record in this case to reflect my correct/new mailing address. I am the: Plaintiff Defendant Witness Other (Specify): My OLD address was: Address Suite/Apartment # City State Zip My NEW address is: Address Suite/Apartment # City State Zip Signature Date Print Name Telephone American LegalNet, Inc. www.FormsWorkFlow.com CC-DR 96 (7/2010) Reset