Fillable Printable Change of Postal Service Address Form

Change of Postal Service Address Form

The Postal Service does not have a database with the current address of all of its customers. It doesn’t need that information since it

delivers to addresses, rather than to individuals. However, if a customer moves and files a change of address order, that information

is kept at the post office serving the last known address. The disclosure of customer name and address information is contained at

section 265.6(d) of our regulations (39 CFR 265), which can be accessed from the FOIA home page. Change of address information

about individuals or families is available only to government agency requesters, to persons needing the information to serve legal

process who meet certain requirements, or pursuant to a court order.

The Postal Service suggests the following format to be used in conjunction with regulations at 39 CFR 265.6(d)(4)(ii) by persons

empowered by law to serve legal process when requesting change of address or boxholder information.

The request should be forwarded to the Postmaster of the last known address.

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: Only one request may be made per completed form. 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)(4)(ii). There is no fee charged for change of address or boxholder information.

1. Capacity of requester (process server, attorney, party representing self):_____________________________________________

2. Statute or regulation that empowers me to serve process (not required for attorney’s 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 this individual is to be served (defendant or witness) ___________________________________________

WARNING: THE SUBMISSION OF FALSE INFORMATION 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 COULD RESULT IN CRIMINAL PENALTIES INCLUDING A FINE OF 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 conjunction with actual or prospective litigation.

_________________________________________ ________________________________________________________

Signature Address

_________________________________________ ________________________________________________________

Printed Name City, State, ZIP Code

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FOR POST OFFICE USE ONLY

_____ No change of address on file New Address or Boxholder Name and Street Address

_____ Moved and left no forwarding address ____________________________________________

_____ No such address ____________________________________________