Affidavit of Name Change and Identity

AFFIDAVIT OF NAME CHANGE AND IDENTITY

Before you use this: Ask the recipient whether it accepts an affidavit, requires its own form, or needs a certified marriage certificate, divorce decree, court order, or other record. If updating a Social Security record, follow the Social Security Administration's application and evidence instructions; this affidavit is not the application. State only facts you know personally, or identify the record on which you rely. Sign before an officer authorized to administer an oath or affirmation, using the certificate required where the act occurs.

Recipient and purpose: [NAME OF AGENCY, INSTITUTION, COURT, OR PERSON; PURPOSE]
Reference or account number, last four characters only if needed: [____ / NONE]

State of [STATE]
County of [COUNTY]

I, [AFFIANT'S CURRENT FULL LEGAL NAME], being sworn or affirmed, state:

1. My current address is [MAILING ADDRESS]. I am [THE PERSON WHOSE NAME CHANGED / OTHER PERSON WITH FIRSTHAND KNOWLEDGE]. If I am another person, my relationship to the subject is [RELATIONSHIP] and my basis of knowledge is [SPECIFIC OBSERVATIONS OR RECORDS].

2. The person whose name is addressed here is [CURRENT FULL LEGAL NAME]. That same person was previously known as [PRIOR FULL NAME AS SHOWN ON THE RELEVANT RECORD]. Other prior names relevant to this recipient are [LIST WITH DATES / NONE].

3. The name changed or was recorded differently because of [MARRIAGE / DIVORCE / COURT ORDER / ADOPTION / CORRECTION OF RECORD / OTHER ACTUAL EVENT] on or about [DATE] in [LOCATION]. The record documenting that event is [DOCUMENT TITLE, ISSUER, DATE, AND RECORD NUMBER IF APPROPRIATE]. I know this because [PERSONAL KNOWLEDGE OR HOW I REVIEWED THE IDENTIFIED RECORD].

4. The prior-name record to which this affidavit relates is [DOCUMENT, ACCOUNT, PROPERTY, LICENSE, OR TRANSACTION], dated [DATE], issued or held by [ISSUER OR RECIPIENT]. The name shown there is [EXACT NAME]. The current-name record, if any, is [DOCUMENT AND ISSUER / NONE].

5. The basis for my statement that these names refer to the same person is [EXPLAIN SPECIFIC FIRSTHAND FACTS OR IDENTIFIED RECORDS; DO NOT RELY ON A BARE CONCLUSION]. Any difference in spelling, middle name, suffix, or order of names is [EXPLAIN / NONE].

6. Supporting records are [ATTACHED AS EXHIBIT A, B, ETC. / SUPPLIED SEPARATELY TO THE RECIPIENT / NOT ENCLOSED]. Each is identified here: [DESCRIPTION, ISSUER, DATE]. I have not included an unredacted Social Security number or other unnecessary sensitive identifier.

7. I make this affidavit so [RECIPIENT] can evaluate whether its record under [PRIOR NAME] belongs to [CURRENT NAME]. The statements above are true to my personal knowledge except where I have identified a record as the source. I have disclosed [ANY KNOWN CONFLICTING INFORMATION OR “NONE KNOWN”].

Affiant's signature: [________________________________]
Printed name: [________________________________]
Date: [__/__/____]
Contact information for a recipient's question: [________________________________]

Notarial jurat

Sworn to or affirmed before me on [__/__/____] by [AFFIANT'S NAME] at [CITY, STATE].

Officer's signature: [________________________________]
Printed name and title: [________________________________]
Commission expiration, if applicable: [__/__/____]
Seal, if required: [________________________________]

Official references

• Texas Secretary of State: affidavit and jurat definitions
• Social Security Administration: corrected-name evidence and application