County Clerk “Background Search Request” Cover Sheet
Page of
(Please use a separate form for each defendant)
Date:
To: Denton County Clerk, Juli Luke
Department: Criminal Clerk Fax : (940) 349-2015
Phone #: ( ) ______-_______ (Required)
Business Check:
Business Name: _________________________________________________________________________
Mailing Address: __________________________________ City ________State______ ZIP___________
Business Phone #: ( ) ______-_______ Phone #: ( ) ______-_______
Drivers License # _________________________ Issuing State ________ Date of Birth ____/_____/_____
Routing #. ______________________ Account # ____________________ Check # ___________________
Email Address___________________________________________________________________________
**Providing an email address will allow your receipt to be emailed to you. **
Authorized Signature: ______________________________________________________
This form authorizes the Merchant (LexisNexis Payment Solutions) to charge my account, for services rendered by the County Clerk’s Office, plus a
$2.50 service fee. Also, authorizing the Merchant to convert their check to an Electronic Funds Transfer or Paper Draft, and to debit their account for the
total transaction amount event that the draft or EFT is returned unpaid, the Customer agrees that a fee of $30.00 or as allowable by law may be charged
to their account via draft or EFT.
Once this request is completed, it cannot be cancelled because the funds are guaranteed. If the customer has any questions regarding this
authorization, they may contact Customer Service at 866-255-1857.
Please provide the following identifiers (minimum of 3):
After we receive the request, our office has a 10-day turnaround.
Name:
Date of Birth:
SSN#:
DL#:
ID#:
• Background Search: $5.00 for initial search plus $5.00 for each additional case found. (background searches will be
mailed back to the address listed above)
• We require at least 3 of the identifiers requested above.
Firm:_____________________________________ From Name: ________________________________
Fax #: ( ) ______-_______ (to receive your copies)
Criminal Email Address: CountyClerkCriminalRequest@dentoncounty.gov
Mailing Address: Denton County Clerk- Criminal 1450 E. McKinney, Denton, TX 76209
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