Instructions for Using Notification of Name/Address Change
The Notification of Name/Address Change form is designed for custodial and non-custodial parents who would
like to change their name or address of record with the Clerk’s office.
1.) Print or type all information on the form.
2.) Sign and date the form.
3.) Custodial parents must have this form notarized.
4.) Submit completed forms to: Clerk of Circuit Court
Attention: Child Support Division
P.O. Box 104
DeLand, FL 32721
Once this form is received by the Clerk’s office your name and/or address will be updated in our database and
this form will be filed in your permanent file in the Family Law Division.
PLEASE REPLY TO: Child Support
P.O. Box 104, DeLand, Fl 32721-0104
NOTIFICATION OF NAME/ADDRESS CHANGE
CASE NO. DATE:
Plaintiff/Petitioner/Payee Defendant/Respondent/Payor
OLD Name/Address:
Street
City State Zip Code
NEW Name/Address:
Street
City State Zip Code
Signature Phone Number
The foregoing instrument was acknowledged before me this Witness my hand in Volusia County,
________ day of ______________________, ___________ State of Florida, this
day of
by______________________________________ Who is
, .
Personally known to me or has produced________________
_________________________________as identification.
LAURA E. ROTH
CLERK OF THE CIRCUIT COURT
Notary Public____________________________________
Print Name By:
Commission #____________________________________ Deputy Clerk
CL-0368-0003
Address Changed On Court Management
(For Clerks Use Only)
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