Name Change Affidavit
I,
Current Name
New Name
Father's/Mother's Name
Address
do hereby solemnly affirm and declare as under:
That I was born as
on
.
That I am the same person who is referred to as
and
.
I have changed my name from
to
and henceforth I will be known as
for all purposes.
That this affidavit is made for the purpose of record and evidence of my change of name.
Verified at
on
that the contents of this affidavit are true and correct to the best of my knowledge and belief.
Signature of Deponent
Date