DISTRICT COURT OF MARYLAND FOR City/County Located at STATE OF MARYLAND OR Court Address Case No. vs. Plaintiff Defendant ADDRESS CHANGE REQUEST Name: Criminal Traffic Civil Trial/Hearing Date: Please update the record in this case to reflect my correct/new mailing address. I am the: Defendant Witness Complainant Plaintiff Petitioner Respondent Other (Specify): My OLD address was: Address Suite/Apartment # City State Zip My NEW address is: (if P.O. Box is given, must also provide street address) Address Suite/Apartment # City State Zip Signature Date Print Name Telephone DC 65 (12/2009) American LegalNet, Inc. www.FormsWorkFlow.com