Change Of Name And-Or Address {Law 376}

IN THE COURT, EIGHTEENTH JUDICIAL CIRCUIT, BREVARD COUNTY, FLORIDA CASE NUMBER: 05 -XXXX-XX NAME ____________________________________ (Type/print first and last name on line) CLOCK IN CHANGE OF NAME/ADDRESS FORM I request my name/address be changed. OLD NAME/OLD ADDRESS ___________________________________ ___________________________________ ___________________________________ ___________________________________ NEW NAME/NEW ADDRESS ___________________________________ ___________________________________ ___________________________________ ___________________________________ ________________________________________ Signature If the Department of Revenue (DOR) is involved in your case, you must notify DOR of any change of address. It is NOT the responsibility of the Clerk of Court. Law 376 / Rev. 12-11-2015 1 American LegalNet, Inc. www.FormsWorkFlow.com