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2. CHANGE OF ADDRESS AND/OR TELEPHONE NUMBER AND/OR EMAIL ADDRESS

   
   

   Paulding County Public Defender

   1387 Industrial Blvd. Suite 103

   Dallas, Ga. 30132

   Office: 770.443.3463 / Fax: 770.443.9936

   Email: PDINTERN@PAULDING.GOV

4. Date:
   Date:
6. DEFENDANT'S:
8. Last Name
9. First Name
10. Middle Name
12. WARRANT / CASE NUMBER(s):
14. NEW ADDRESS:
16. Street Address:
17. Building / Apt / Suite
19. City
20. State
21. Zip
23. NEW TELEPHONE NUMBER(s):
25. Home Number
26. Cell Number
27. Alternate Number
29. NEW EMAIL ADDRESS:
31. Email:
37. I HEREBY SWEAR OR AFFIRM THAT ALL OF THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
39. On This Date:
    On This Date:
40. Print Name:
42. E Signature (Digital Signature) or Physically Sign Later:*
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field