Change Of Address Form

CHANGE OF ADDRESS FORM Department of Criminal Records 16th Judicial Circuit Court, Jackson County, Missouri Kansas City fax: (816) 881- 3420 / Independence fax: (816) 881- 4691 *I certify that I am the (check one): Defendant Attorney Bond Assignee Other ___________________________ Victim *NOTE: You are not authorized to change any address other than your own. Name ____________________________________________________________________________ Case Number ______________________________________________________________________ Case was heard in: Kansas City Independence PREVIOUS ADDRESS Street Address _____________________________________________________________________ City ________________________________________ State ___________ Zip __________________ NEW ADDRESS Street Address ______________________________________________________________________ City ________________________________________ State ___________ Zip ___________________ Home Phone (____) _____________________ Mobile/Other Phone (____) _____________________ Email address _______________________________________________________________________ I acknowledge that the above information is true and correct. _____________________________________________ SIGNATURE __________________________ DATE If your case was heard in Kansas City, mail or fax to: Department of Criminal Records 1315 Locust Kansas City, MO 64106 (FAX) 816-881-3420 Department of Criminal Records 308 W. Kansas, Suite 310 Independence, MO 64050 (FAX) 816-881-4691 04/12 American LegalNet, Inc. www.FormsWorkFlow.com If your case was heard in Independence, mail or fax to: