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Get Request for Change of Address or Boxholder Information Needed for Service of Legal Process

Print Clear Form Postmaster Date City State Zip Code Request for Change of Address or Boxholder Information Needed for Service of Legal Process Please furnish the new address or the name and street address if a boxholder for the following NAME ADDRESS NOTE The name and last known address are required for change of address information. The name if known and post office box address are required for boxholder information. The following information is provided in accordance with 39 CFR 265. 6 D 6 ll. There is no fee for providing boxholder information* The fee for providing change of address information is waived in accordance with 39 CFR 265. 6 d 1 and 2 and corresponding Administrative Support Manual 352. 44a and b. 1. Capacity of requester e*g* process server attorney party representing himself 2. Statute or regulation that empowers me to serve process not required when requester is an attorney or a party acting pro se except a corporation acting pro se must cite statute 3. The names of all known parties to the litigation 4. The court in which the case has been or will be heard 5. The docket or other identifying number if one has been issued 6. The capacity in which the individual is to be served e*g* defendant of witness WARNING THE SUBMISSION OF FALSE INFORMATION EITHER 1 TO OBTAIN AND USE CHANGE OF ADDRESS INFORMATION OR BOXHOLDER INFORMATION FOR ANY PURPOSE OTHER THAN THE SERVICE OF LEGAL PROCESS IN CONNECTION WITH ACTUAL OR PROSPECTIVE LITIGATION OR 2 TO AVOID PAYMENT OF THE FEE FOR CHANGE OF ADDRESS INFORMATION COULD RESULT IN CRIMINAL PENALTIES INCLUDING A FINE UP TO 10 000 OR IMPRISONMENT OF NOT MORE THAN 5 YEARS OR BOTH TITLE 18 U*S*C. SECTION 1001 I certify that the above information is true and that the address information is needed and will be used solely for service of legal process in connection with actual or prospective litigation* Signature Address Printed Name FOR POST OFFICE USE ONLY No change of address order on file. Postmark Not known at address given* Moved left no forwarding address. No such address. NEW ADDRESS OR BOXHOLDER S NAME AND STREET ADDRESS. 6 D 6 ll. There is no fee for providing boxholder information* The fee for providing change of address information is waived in accordance with 39 CFR 265. 6 d 1 and 2 and corresponding Administrative Support Manual 352. 44a and b. 1. Capacity of requester e*g* process server attorney party representing himself 2. 6 d 1 and 2 and corresponding Administrative Support Manual 352. 44a and b. 1. Capacity of requester e*g* process server attorney party representing himself 2. Statute or regulation that empowers me to serve process not required when requester is an attorney or a party acting pro se except a corporation acting pro se must cite statute 3. Statute or regulation that empowers me to serve process not required when requester is an attorney or a party acting pro se except a corporation acting pro se must cite statute 3. The names of all known parties to the litigation 4. The court in which the case has been or will be heard 5. .

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