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Other Form Names
An affidavit of name change is sometimes referred to by the below names:
- Name Change Affidavit
- Affidavit for Name Change
This type of document should not be confused with a “Petition for Name Change,” a form submitted to the court by an individual requesting to change their legal name.
Sample
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AFFIDAVIT OF NAME CHANGE
I, the Affiant, being duly sworn, hereby affirm on [MM/DD/YYYY] that:
My present full legal name is [CURRENT NAME].
I was born on [MM/DD/YYYY] in [PLACE OF BIRTH]. I currently reside at [ADDRESS].
I changed my full legal name from [FORMER NAME] to my current name on [MM/DD/YYYY].
The change of name request is not for any fraudulent or wrongful purpose, detrimental to the rights or interests of any other person, or prohibited by or violative of any judicial or administrative adjudication.
Under penalty of perjury, I hereby declare and affirm that the Affidavit is signed by me and all its contents, to the best of my knowledge, are true and correct.
Affiant’s Signature: _______________________ Date: _________________
NOTARY ACKNOWLEDGMENT
| A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. |
State of [STATE]
County of [COUNTY]
The foregoing instrument was acknowledged before me, [NOTARY NAME], on [MM/DD/YYYY], by the undersigned, [AFFIANT NAME], who is personally known to me or satisfactorily proven to me to be the person whose name is subscribed to the within instrument.
WITNESS my hand and official seal.
Signature: ____________________________ (Seal)