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2. CHANGE OF ADDRESS REQUEST
4. Case or Citation Number
6. Defendant Name*
7. Date of Birth*
9. Defendant Email*
11. New Address Line 1*
13. New Address Line 2
15. City*
16. State*
17. Zip Code*
19. Daytime Phone
20. Cell Phone
22. DEFENDANT SIGNATURE -- Type in Full Name*
24. PARENT OF JUVENILE DEFENDANT SIGNATURE -- Type in Full Name (if Defendant is under 18 years of age)
26. Today's Date
    Today's Date

28. By typing in your signature above, you authorize a change of address and hereby swear and affirm the information you have provided is true and accurate to the best of your knowledge.

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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field