Fill and Sign the Request for Address of Record Request for Address of Record Form

Form 03EN009E (CSED-9) revised 7-8-2010 may continue on next page, page 1 of 3 Oklahoma Child Support Services Central Case Registry Request for Address of Record I am requesting the address of record for this person:First name Middle initial Last name Date of birth Social Security number Oklahoma child support case numberFGN: District court case number County State List child(ren) in this case: First name Middle initial Last name Date of birth Last name of custodial person (CP) First Middle S ocia l S ecu rit y nu m be r Last name of noncustodial person (NCP) First Middle Social Security number Under 43 O.S. § 112A, the last known address of record will be released to the person requesting address disclosure. Home addresses are not disclosed if prohibited by a court order granted for the protection of a parent or custodian, or if the Oklahoma Child Support Services (OCSS) case has been assigned a family violence indicator.I a m a n a uth oriz e d p ers o n to r e quest th is in fo rm atio n u nder O kla hom a la w ( 4 3 O .S . § 1 12A ) be ca use I a m th e: ( C heck o ne) custodian of the child(ren).noncustodial parent.attorney for the custodian. OBA no.: attorney for the noncustodial parent.OBA no.: other party or authorized representative: Form 03EN009E (CSED-9) revised 7-8-2010 may continue on next page, page 2 of 3I am requesting this address of record for service of process for the following purpose: supportvisitationcustody I state under penalty of perjury under the laws of the State of Oklahoma that the forgoing is true and correct. Type or print name of requestor Signature of requestor Date Notice: The person whose address of record you are requesting may be notified of your request. A copy of page one of this request may be sent with the notice. OCSS allows a 15-day time period for a response. Within 45 days after OCSS receives your request, OCSS will notify you if your request can be processed.Complete the following information about yourself. This information is for identification and communication with you. This page will not be sent with the notice to the non-requesting party.Information about the person requesting address disclosure.First name of requestor Middle initial Last name Social Security number if CP or NCP Oklahoma child support case numberFGN: District court case number County State Date of birth, If CP or NCP Street address City State Zip Area code H om e te le pho ne n um ber Area code W ork te le pho ne n um ber E -m ail a ddre ss, o ptio nal Form 03EN009E (CSED-9) revised 7-8-2010 may continue on next page, page 3 of 3 Purp ose o f fo rm Form 03EN009E may be used by a custodial person (CP), noncustodial parent (NCP), the attorney for either, or an authorized person to request disclosure of the custodial person's or the noncustodial parent's address of record. In str u ctio ns  Enter name, date of birth, and Social Security number of the person whose address of record you are requesting.Ente r th e O CSS c a se n um ber. T his is a ls o c a lle d th e F G N n um ber.  Enter the district court case number along with the county and state where it was entered.Ente r th e n am es a nd d ate s o f b ir th o f u p to fo ur c h ild re n in th is c a se .  Ente r th e n am es a nd S ocia l S ecu rit y n um bers o f th e C P a nd th e N CP. Check th e a ppro pria te b ox to in dic a te y o u a re th e C P, N CP, a tto rn ey fo r th e C P o r NC P, o r a n a uth oriz e d re pre se nta tiv e . If y o u a re th e a tto rn ey, e nte r y o ur O kla hom a Ba r A sso cia tio n n um ber. If y o u a re a p arty o r a uth oriz e d re pre se nta tiv e n ot lis te d, ch eck th e o th er b ox a nd e xp la in y o ur s ta tu s a nd a uth orit y fo r m akin g th is r e quest. Check th e b ox c o rre sp ondin g w it h th e p urp ose fo r y o ur re quest. U nder O kla hom a la w , a ddre sse s o f re co rd a re fo r se rv ic e o f p ro ce ss in su pport, vis it a tio n, a nd cu sto dy a ctio ns. [4 3 O .S . § 1 12A ] Typ e o r p rin t y o ur n am e, a nd s ig n a nd d ate th e fo rm . If y o u a re th e C P o r a N CP, e nte r y o ur S ocia l S ecu rit y n um ber. Ente r y o u r m ailin g a ddre ss. In clu de a s tr e et a d dre ss o r a p ost o ffic e b ox n um ber wit h c it y , s ta te , a nd z ip c o de. If y o u a re th e C P o r a N CP, e nte r y o ur d ate o f b ir th .  Ente r y o ur h om e a nd w ork te le phone n um bers . In clu de a re a c o de(s ). Ente r y o ur e -m ail a ddre ss ( n ot r e quir e d). R outin g Make a copy of the form to keep for yourself, and return the original completed form to: OCSS, Central Case Registry Attn: Address Disclosures P. O. Box 248843 Oklahoma City, OK 73124-8843 Questions? Telephone 918-295-3500 in the Tulsa area; 405-522-2273 in the Oklahoma City area; or 1-800-522-2922 toll free. For TTY dial 711.