Declaration of Legal Name Change
I, the undersigned, declare that I am 18 years of age or older and further declare:
1.	I,	 [name currently used], was born 	 [name on birth certificate] in the County of	 [county where born] in the State of 	 [state where born] on 	 [birthdate, including year].
2.	I hereby declare that I have changed my legal name, and from now on will be exclusively known as		 [new name].
3.	My legal name change was completed by order of the 	 County Superior Court in case no. 	 on 	, 	. A copy of the court order is attached to this declaration.
4.	Notice is hereby given to all agencies of the State of 	 	[state where you reside], all agencies of the federal government, all creditors, and all private persons, groups, businesses, corporations, and associations of said legal name change.
5.	Please revise all relevant records accordingly.
I declare under penalty of perjury under the laws of the State of 	 [state where you reside] that the foregoing is true and correct.
Signature, new name 	 Date	
Signature, old name 	 Date