Verification of Contact Information Form
COURT AND DETENTION SERVICES 2014 MAIN ST DALLAS, TX 75201
CTS-FRM-726 REVISION 5
(214) 670-0109
04/1/2022
This form must be filled out and signed by the person that received the citation.
Please PRINT the following information:
Name: __________________________________________________ Date of Birth: __________________
Driver’s License / State ID#: _______________________________________ State: __________________
Cell Phone: ________________________________ Home Phone: ________________________________
E-Mail Address: ___________________________________________________________________________
Home Address: ___________________________________________________________________________
City: __________________________________ State: __________________ Zip: __________________
If the mailing address is different than the home address, please fill out mailing address information:
Mailing Address: __________________________________________________________________________
City: __________________________________ State: __________________ Zip: __________________
I would like to receive text for official Court notices. (Please check one): Yes No
Do you require a language translator or accommodation under the Americans with Disabilities Act (ADA) for in-
person or virtual hearings? (Please check one): Yes No
If Yes, what language is required or provide detailed information about the accommodation (ie: Translator, ASL
interpreter, UbiDuo, large print, etc.) Please be specific with what you are requesting: ___________________
________________________________________________________________________________________
I understand that any paperwork the Court sends to me will be mailed to the address that I have
provided the Court. If my address changes, I will contact the Court by mail or in person to provide the
updated information within ten (10) days.
I, (Print Name) ___________________________________________________________________________,
verify, under penalty of perjury under the laws of the United States of America, that the above
information is true and correct.
Defendant Signature: __________________________________________________ Date: _____________
