BALTIMORE COUNTY PUBLIC SCHOOLS
BALTIMORE COUNTY PUBLIC SCHOOLS
OFFICE OF PAYROLL
6901 CHARLES STREET, BUILDING E
TOWSON MD 21204
443-809-4240
FAX 410-887-7610
CHANGE OF NAME/ADDRESS FORM
Instructions
You may change your address on-line. Access the BCPS intranet web-site at . Click on: 1) Employee Self Service on the right side of the screen 2) Employee Information on the left side of the screen 3) Address in the circle which appears on the screen 4) Edit box
OR, you may download the form, complete it, and send it to the Office of Payroll for processing.
You may NOT change your name on-line. The Social Security Administration requires that we verify a name change by asking for a copy of your new Social Security Card. If you are reporting a name change, please attach a copy of your new Social Security Card to this form and send it to the Office of Payroll. We cannot change your name until we receive a copy of your new Social Security Card.
NEW NAME Last
EMPLOYEE ID NUMBER
First
Middle/Maiden
FORMER NAME Last
EFFECTIVE DATE OF CHANGE
First
Middle/Maiden
MONTH DAY
YEAR
NEW ADDRESS
Number and Street
City
State
Zip
Telephone
A change of address MAY change your local tax withholding jurisdiction and you MAY need to complete a new W4 Card
FORMER ADDRESS
Number and Street
City
State
Zip
Telephone
SIGNATURE
DATE
PRINT YOUR NAME
EMPLOYEE ID NUMBER
Change of Name_Adress Form.xlsx
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