DISTRICT COURT OF MARYLAND FOR
City/County
Located at
Court Address
Case No.
STATE OF MARYLAND
OR
vs.
DC-065 (Rev. 02/2019)
Plaintiff
My OLD address was:
Address
Suite/Apartment #
City
State
Zip
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 NEW address is:
Address
Suite/Apartment #
City
State
Zip
(if P.O. Box is given, must also provide street address)
Signature
Date
Print Name
Telephone
CERTIFICATE OF SERVICE
I certify that I served a copy of this request upon the following party or parties by mailing first class mail, postage
prepaid hand delivery, on to:
Date
Address
Signature of Party Serving
Address
Name
Name
Date
Reset
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