I, [YOUR NAME], residing in Seattle, WA 98101, do hereby solemnly affirm and declare as follows:

1. I am currently known as [YOUR NAME], and I am requesting a name change due to my recent marriage. My spouse’s name is Jolie Cassin, and I have made the decision to change my name to reflect my new status.

2. I wish to change my name to [YOUR NAME] effective as of January 15, 2050.

3. This change is made for the following reasons:

   • To reflect my new marital status and to align my name with my spouse’s surname.

4. I understand that this affidavit will serve as a formal declaration of my name change and will be used for the purposes of updating my personal records with various institutions, including but not limited to:

   • Government agencies

   • Financial institutions

   • Employers

   • Educational institutions

5. I further affirm that I am not making this name change for any fraudulent purposes or to evade any debts or legal obligations.

6. This affidavit has been executed on this 5th day of October, 2050.

[YOUR NAME]
Affiant

Notary Public

Subscribed and sworn to before me this 5th day of October, 2050.

Trace Durgan
Notary Public
My Commission Expires: March 31, 2055

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