HARRIS COUNTY CHILD SUPPORT REQUEST FOR NAME/ADDRESS CHANGE EMAIL: FAX: MAIL TO: CHILDSUPPORT@HCDISTRICTCLERK.COM 713-755-4359 CHRIS DANIEL, DISTRICT CLERK POST OFFICE BOX 4651 HOUSTON, TEXAS 77210 ATTENTION: CHILD SUPPORT DEPARTMENT SUBMIT THIS COMPLETED FORM WITH SIGNATURE WHEN UPDATING ADDRESS INFO, SUBMIT COPY OF VALID STATE ISSUED PHOTO ID (PHOTO, ADDRESS, AND SIGNATURE MUST BE CLEARLY VISIBLE) WHEN UPDATING LAST NAME, SUBMIT MARRIAGE CERTIFICATE COPY AND COPY OF VALID STATE ISSUED PHOTO (PHOTO, ADDRESS, AND SIGNATURE MUST BE CLEARLY VISIBLE) IF LICENSE OR ID HAS EXPIRED, PROVIDE AN ADDITIONAL VALID FORM OF ID (e.g. CREDIT CARD, PASSPORT, etc.) **IF YOU ARE SUBMITTING AN ADDRESS CHANGE TO UPDATE THE COURTS SYSTEM PER COURT ORDER, PLEASE SUBMIT YOUR UPDATE IN WRITING DIRECTLY TO THE COURTS.** CHECK ALL THAT APPLY ___ NAME CHANGE (PLEASE PRINT) TODAY'S DATE _____________ ___ ADDRESS CHANGE CAUSE #______________________ YOUR NAME: _______________________________________________ Select One: I am the Payor (make payments) ___ I am the Payee (receive payments) ___ ADDRESS: __________________________________________________ CITY: _____________________ STATE: _____ ZIP CODE:________ CELL: ________________________ HOME:_____________________ E-MAIL ADDRESS: ________________________________________ DRIVER'S LICENSE NO. _______________SSN ________________ SIGNATURE ______________________________________________ If you have any questions regarding this form, please call us at 713-755-7300. HCCSNAC150824 American LegalNet, Inc. www.FormsWorkFlow.com