Attorney Request Change Of Name Address

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WAYNE COUNTY PROBATE COURT
Attorney Request
Change of Name, Address, and/or
Federal Tax Identification Number
Please indicate request(s)
Change of Address
Change of Name
New/Change of E-Mail Address
Include Previous Name
Change of Tax ID or SSN
(W-9 must be attached)
New Attorney
Please Print Clearly
Please Print Clearly
P
Name
Bar Number
Address
City, State, Zip Code
Telephone Number
Fax Number
E-Mail Address (Various assignment packets are sent by e-mail.)
Note : TIN or SSN must be on file with Wayne County Probate Court Office of Budget and
Management if you receive payments for Court assignments. All changes or adds of TIN or
SSN must be accompanied by an IRS W-9 form. This form can be obtained from WCPC's
Office of Budget & Management or
W-9 attached
Please check the appropriate box indicated below.
Change is for Court Use only (mailing of correspondence)
Change is for County Use only (mailing of payment)
Change is for both Court and County Use
Signature:
Date:
(Must be signed by the requesting attorney)
PLEASE SUBMIT THE COMPLETED REQUEST TO:
Wayne County Probate Court
Office of Budget & Management
1305 Coleman A. Young Municipal Center
Two Woodward Ave.
Detroit, MI 48226
Fax: (313) 967-4055
DO NOT WRITE BELOW THIS LINE - FOR COURT USE ONLY
Entered by: _________________________________
Date: ___________________
WCPC 21 (11/10)

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