Name Change Affidavit: One and the Same Person (Free Template)

STATE OF [STATE]                    )
                                    )  ss.
COUNTY OF [COUNTY]                  )


                          NAME CHANGE AFFIDAVIT
                  (One-and-the-Same Identity Affidavit
                   Linking Prior Name to Current Name)


    BEFORE ME, the undersigned authority, on this day personally
appeared [Affiant Full Legal Name (Current)] (the "Affiant"),
who, being by me first duly sworn upon oath, deposed and stated
as follows:


    1.  AFFIANT QUALIFICATIONS. Affiant's full legal name as of
        the date of this Affidavit is [Affiant Current Full
        Legal Name]. Affiant resides at [Street Address, City,
        County, State, ZIP]. Affiant is over the age of eighteen
        (18) years and competent to make this Affidavit.
        Affiant has personal knowledge of the facts stated
        herein.

    2.  IDENTITY. Affiant was born on [Date of Birth] in [City,
        State, Country of Birth]. Affiant's Social Security
        number ends in [Last Four Digits Only]. Affiant's
        current state-issued photo identification is:

            Type:                   [Driver's License /
                                     State ID / U.S. Passport /
                                     Permanent Resident Card]
            Issuing Authority:      [State / U.S. Department
                                     of State / USCIS]
            ID / License Number:    [Number]
            Date of Issue:          [MM/DD/YYYY]
            Date of Expiration:     [MM/DD/YYYY]

    3.  PRIOR NAME. Affiant was previously known by, and is
        identified in prior records by, the following name (the
        "Prior Name"):

            Prior Full Legal Name:  [Full Prior Legal Name]
            Variants on prior
            records (if any):       [Any spelling variants,
                                     hyphenated forms, or
                                     middle-name/initial
                                     variants]
            Dates Affiant was
            known by the Prior
            Name:                   [From MM/YYYY to MM/YYYY]

    4.  CURRENT NAME. Affiant's current full legal name (the
        "Current Name") is:

            Current Full Legal
            Name:                   [Full Current Legal Name]
            Date the Current Name
            became Affiant's legal
            name:                   [MM/DD/YYYY]

    5.  REASON FOR THE CHANGE. Affiant changed from the Prior
        Name to the Current Name by reason of (select the
        applicable basis and attach the corresponding primary
        document as Exhibit A):

        [   ] (a) Marriage. Affiant and [Spouse Full Legal Name]
                  were married on [Date of Marriage] in [City,
                  County, State]. Marriage certificate attached
                  as Exhibit A.

        [   ] (b) Divorce or annulment restoring a prior name.
                  Affiant's marriage to [Former Spouse Full
                  Legal Name] was dissolved or annulled by
                  decree entered on [Date] in [Court Name],
                  Cause No. [____], which decree restored
                  Affiant's prior name. Certified decree
                  attached as Exhibit A.

        [   ] (c) Court order. A court of competent
                  jurisdiction entered an order changing
                  Affiant's name on [Date], in [Court Name],
                  Cause No. [____]. Certified copy of the
                  order attached as Exhibit A.

        [   ] (d) Naturalization. Affiant was naturalized as a
                  citizen of the United States on [Date]; the
                  Certificate of Naturalization reflects
                  Affiant's Current Name. Copy of the
                  Certificate of Naturalization attached as
                  Exhibit A.

        [   ] (e) Common-law change of name. Affiant has
                  continuously, openly, and in good faith used
                  the Current Name since [Date], without intent
                  to defraud any creditor, government agency,
                  or other person. Affiant resides in a state
                  that recognizes common-law name change.
                  Affiant attaches as Exhibit A documentation
                  evidencing continuous public use of the
                  Current Name (utility bills, bank
                  correspondence, employer records, tax
                  returns).

        [   ] (f) Correction of administrative misspelling. The
                  Prior Name reflects a misspelling or
                  transcription error on a prior record. The
                  Current Name is, and always has been,
                  Affiant's true legal name. Affiant attaches
                  as Exhibit A a copy of the birth certificate,
                  passport, or other primary identity document
                  showing the Current Name.

    6.  ONE-AND-THE-SAME STATEMENT. Affiant solemnly affirms
        that the person identified as [Prior Full Legal Name]
        on prior records, accounts, instruments, or
        registrations, and the person identified as [Current
        Full Legal Name] on this Affidavit, are ONE AND THE
        SAME PERSON, and that Affiant is that person.

    7.  RECORDS TO BE UPDATED. Affiant submits this Affidavit
        in connection with the updating of one or more of the
        following records to reflect the Current Name:

        [   ] Social Security record
        [   ] U.S. passport
        [   ] State driver's license or state-issued ID
        [   ] Voter registration
        [   ] Bank or credit union account (Institution:
              ________________________________)
        [   ] Brokerage or retirement account (Custodian:
              ________________________________)
        [   ] Real-property deed or title (Property:
              ________________________________)
        [   ] Employer payroll or benefits record (Employer:
              ________________________________)
        [   ] Professional license (Board / License Type:
              ________________________________)
        [   ] Diploma, transcript, or alumni record (School:
              ________________________________)
        [   ] Other (specify): _______________________________

    8.  CONTINUING USE OF PRIOR NAME (if applicable). Affiant
        [does / does NOT] continue to use the Prior Name for
        any purpose. If yes, the Prior Name is currently used
        for the following limited purposes only: [Specify, e.g.,
        professional publications under maiden name, prior-year
        tax-return continuity, security-clearance file
        continuity].

    9.  NO FRAUDULENT PURPOSE. Affiant has not changed names,
        and is not seeking the record update described in
        Paragraph 7, for any of the following purposes: to
        evade or defraud any creditor; to evade any civil
        judgment, criminal warrant, or court order; to
        misrepresent identity to any government agency; or to
        avoid any pending civil or criminal proceeding. Affiant
        is not a registered sex offender. Affiant is not the
        subject of any pending criminal indictment, information,
        or arrest warrant.

    10. INDEMNIFICATION OF RECIPIENT. Affiant acknowledges that
        the institution, agency, or recording office to which
        this Affidavit is delivered (the "Recipient") is acting
        in reliance on this Affidavit when updating its
        records. Affiant agrees to indemnify and hold the
        Recipient harmless from any loss caused by the falsity
        of any statement in this Affidavit. This indemnification
        does not waive any rights of the Recipient under
        applicable state or federal law and does not limit the
        Recipient's right to require additional primary
        documents (a certified marriage certificate, certified
        divorce decree, certified court order, Certificate of
        Naturalization, or REAL-ID-compliant identification)
        before completing the record update.

    11. NOT A LEGAL NAME CHANGE. Affiant understands that this
        Affidavit is an evidentiary identity statement only and
        does not, by itself, legally change Affiant's name in
        any state that requires a court order or marriage-based
        statutory change. Where state law or institutional
        policy requires a court order, marriage certificate, or
        naturalization certificate to effect the change of
        name on its records, Affiant will produce that primary
        document in addition to this Affidavit.


    FURTHER AFFIANT SAYETH NAUGHT.


    Executed on this ____ day of ________________, 20____.


                                ____________________________________
                                AFFIANT
                                [Current Full Legal Name]
                                Specimen signature in Current Name


                                ____________________________________
                                AFFIANT
                                [Prior Full Legal Name]
                                Specimen signature in Prior Name


PENALTY-OF-PERJURY DECLARATION (Federal Alternative).
Pursuant to 28 U.S.C. Section 1746, Affiant declares under
penalty of perjury under the laws of the United States of
America that the foregoing is true and correct.

    Executed on _______________ at _______________________.


                                ____________________________________
                                AFFIANT


                          JURAT / NOTARY ACKNOWLEDGMENT


STATE OF ______________________ )
                                ) ss.
COUNTY OF _____________________ )

    Sworn to and subscribed before me by [Affiant Current Full
Legal Name], also known as [Affiant Prior Full Legal Name], on
this ____ day of ________________, 20____, who is personally
known to me OR produced ______________________________ as
identification, and who being duly sworn deposed that the
statements in the foregoing Affidavit are true and correct of
the Affiant's own personal knowledge.


                                ____________________________________
                                NOTARY PUBLIC, State of __________

                                Printed Name: ______________________

                                My Commission Expires: _____________

                                Notary Seal:




EXHIBITS:
    Exhibit A:  Primary document evidencing the name change
                under the basis selected in Paragraph 5
                (certified marriage certificate; certified
                divorce decree; certified court order;
                Certificate of Naturalization; or, for common-
                law change, documentary evidence of continuous
                public use).
    Exhibit B:  Photocopy of Affiant's current government-
                issued photo identification (showing the
                Current Name where the primary document and
                the ID match; otherwise the ID showing the
                Prior Name with a notation that the ID is
                pending update).
    Exhibit C:  Copy of Affiant's Social Security card (if the
                update being requested is to a financial,
                employer, or tax record that requires SSN
                cross-verification).