County Clerk “Background Search Request” Cover Sheet
Page of
(Please use a separate form for each defendant)
Date:
To: Denton County Clerk, Juli Luke
From Name: ________________________________ Firm:_____________________________________
Fax #: ( ) _______-_______ (to receive your copies) Phone #: ( ) ________-___________ (Required)
Credit Card:
Name as it appears on Card: ________________________________________________________________
Credit Card Acct #:_____________________________________________________Exp. Date:_____/____
(Check which applies) Master Card _________ Discover __________ American Express _________Visa_________
Mailing Address: _________________________________City ________State________ ZIP___________
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.
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.
Department: Criminal Clerk Fax : (940) 349-2015
Criminal Email Address: CountyClerkCriminalRequest@dentoncounty.gov
Mailing Address: Denton County Clerk- Criminal 1450 E. McKinney, Denton, TX 76209
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