Change Of Address Form - Illinois State Disbursement Unit
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1ILLINOIS
STATE DISBURSEMENT UNIT
P.O. Box 5921
Carol Stream, IL 60197-5921
Customer Service: (877) 225-7077
CHANGE OF ADDRESS FORM
FIRST NAME
LAST NAME
List all docket numbers to which the change of address will apply:
Docket Number
Issuing County
Old Address
Street Address
City
State
Zip
New Address
Street Address
City
State
Zip
Effective Date of Address Change:
Daytime Telephone:
Home Telephone:
Signature (required to validate this request)
Date
PLEASE NOTE – YOU MUST INCLUDE A COPY OF YOUR
DRIVER’S LICENSE OR STATE ID WITH THIS FORM.
(Please check the appropriate box and include the ID)
Copy of Driver’s License
Copy of State ID
If your docket was issued from Cook County
Subscribed and sworn to before me this
and you do not have a child support case with
__________Day of __________,20__,
the Department of Healthcare and Family
_______________________________
Services, you must have this request notarized.
Notary Public
If the form has been notarized please mail to
address listed above.
Please fax the complete form to (630) 221-2312 or mail to address listed above.
If you would like to receive notifications from the State Disbursement Unit that there has been a disbursement on your
child support case listed above, please complete the requested information below.
Mobile phone number: _________________________________
Email: _________________________________________________
(Standard Text Messaging rates may apply)
(Please print and write clearly)
Preference (Circle One): Text Message Email Message
If both mobile phone number and email address are provided but no preference is indicated the notification method will default to email.
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