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State of
County of
Current Name of Applicant:
Approximate Date Current Name Was Assumed:
Former Name of Applicant:
Applicant's Date of Birth :
Number of Years You Have Known the Applicant:
| By Current Name | By Former Name |
Your Relationship to the Applicant:
The variance in the applicant's name shown on his/her birth records and the name currently used:
Current name is used exclusively and for all purposes.
's current address is , ,
I solemnly swear (or affirm) that the information given above by me is true and correct to the best of my knowledge and belief, that the applicant named above has been known by both his or her present and former names as stated and is one and the same person; that the applicant is known by his or her present name to friends and relatives, and in the community in which he or she is residing.
| ___________________________________ | ______________________ |
| Date |
,
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Yes, an Affidavit of Name Change Form needs to be acknowledged by a notary public. Witnesses are not required by law.
