STATEMENT/CHANGE OF RESIDENTIAL ADDRESS
CAUSE NUMBER: _______________
STATE OF TEXAS
§
IN THE MUNICIPAL COURT
VS.
§
CITY OF __________________
___________________
§
__________COUNTY, TEXAS
According to the records of the Court, the following is the residential address of the Defendant named above:
_______________________________
_______________________________
_______________________________
_______________________________
Check, sign, and date beneath ONE of the following:
The information stated above is the CORRECT residential address of the Defendant named above. The Court has given me
written notice of my continuing obligation to keep the Court informed as to changes in the Defendant’s correct residential
address. I understand that violation of my obligation is a Class C misdemeanor punishable by a fine not to exceed $500.00
dollars (excluding fees and costs) and may result in my arrest.
________________________________________
________________________________________
Signature
Date
The information stated above is an INCORRECT residential address for the Defendant named above. I understand that
knowingly making a false statement in a governmental record is a Class A misdemeanor. The CORRECT residential address
for the Defendant is:
_______________________________
_______________________________
_______________________________
_______________________________
The Court has given me written notice of my continuing obligation to keep the Court informed as to changes in the Defendant’s
correct residential address. I understand that violation of my obligation is a Class C misdemeanor punishable by a fine not to
exceed $500.00 dollars (excluding fees and costs) and may result in my arrest.
________________________________________
________________________________________
Signature
Date
Received, this the ___ day of ______________, 20___.
________________________________________
(Judge) (Clerk) (Deputy Clerk), Municipal Court
JUVENILES 08/13
TMCEC 2013 FORMS BOOK
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