Fillable CHANGE OF NAME/ADDRESS REQUEST (Virginia Department of Motor Vehicles)

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CHANGE OF NAME/ADDRESS REQUEST (Virginia Department of Motor Vehicles)

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Commonwealth of Virginia
Department Of Social Services
DIVISION OF CHILD SUPPORT ENFORCEMENT
CHANGE OF NAME/ADDRESS REQUEST
ALL NAME/ADDRESS CHANGES MUST BE IN WRITING AND SUBMITTED TO THE
DISTRICT OFFICE THAT MANAGES YOUR CASE.
District Office addresses, fax numbers and areas served can be found on our website at
HTTP://CHILDSUPPORT.VIRGINIA.GOV
______________________________________
Custodial Parent
______________________________________
Noncustodial Parent
______________________________________
DCSE Case No.
COMPLETE THIS SECTION WITH YOUR FORMER NAME/ADDRESS (Please Print)
________________________________________________________________
Former Name
________________________________________________________________
Former Address (no., street, city or town, state, and ZIP code)
____________________________________________________________________________
Former Work/Home Telephone No.
COMPLETE THIS SECTION WITH YOUR NEW NAME/ADDRESS (Please Print)
________________________________________________________________
Name
________________________________________________________________
New Address (no., street, city or town, state, and ZIP code)
____________________________________________________________________________
New Work/Home Telephone No.
_____________________________________
Signature
________________
Date
VIRGINIA LAW REQUIRES EACH PARENT TO PROVIDE NOTIFICATION OF A CHANGE
IN HIS OR HER HOME AND WORK ADDRESSES AS WELL AS HOME OR WORK
TELEPHONE NUMBERS. ALL NAME/ADDRESS CHANGES MUST BE IN WRITING AND
SUBMITTED TO THE DISTRICT OFFICE THAT MANAGES YOUR CASE. (§63.2-1916) (§20-
60.3)
Internet/2000 DCSEP-821-Rev. 7/04
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CHANGE OF NAMEADDRESS REQUEST (Virginia Department of Motor Vehicles)

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Completed 23 February 2022

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