Affidavit for Change of Name in Birth Certificate
I. Affidavit Introduction
This Affidavit is made and executed by the undersigned individual for the sole purpose of effecting a change of name on the birth certificate issued to me. I solemnly affirm and declare the information provided herein to be accurate and true to the best of my knowledge and belief.
II. Affiant Information
A. Personal Details
Full Name: Philip Mitchell
Date of Birth: December 9, 2050
Place of Birth: Milwaukee, WI 53202
Address: Milwaukee, WI 53202
B. Identification
III. Birth Certificate Details
Current Name on Birth Certificate: Phillipp Mitchells
Proposed New Name: Philip Mitchell
Reason for Name Change: wrong spelling and wrong last name
IV. Supporting Information
This section includes any additional details necessary to substantiate the need for the change of name, such as:
Supporting Documents (e.g., marriage certificate, court orders, etc.)
Any legal obligations or contracts affected by the name change
Impact on personal records or identification
V. Declaration
I hereby declare that the facts stated herein are true, and I make this solemn declaration conscientiously, believing the same to be true and by virtue of the laws applicable to affidavits. I understand that any false statement provided in this affidavit may subject me to penalties under the law.
VI. Signature
Philip Mitchell
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