Affidavit of Name Change

State of California County of Marin County Current Name of Applicant: Sara Lee Approximate Date Current Name Was Assumed: February 15, 2010 Former Name of Applicant: Margaret Sara Lee Applicant's Date of Birth : February 06, 1991 Number of Years You Have Known the Applicant: By Current Name 2 year By Former Name 10 years

Your Relationship to the Applicant: family friend The variance in the applicant's name shown on his/her birth records and the name currently used: The Affiant is known to by family and friends by her middle name. The only difference between the two names is that the new name drops the legal first name Current name is used exclusively and for all purposes. Sara Lee's current address is 12 H St Apt #3, San Rafael, California 94901 I solemnly swear (or affirm) that the information given above by me is true and correct to the best of my knowledge and belief, that the applicant named above has been known by both his or her present and former names as stated and is one and the same person; that the applicant is known by his or her present name to friends and relatives, and in the community in which he or she is residing.

___________________________________ Sara Thompson 12 H St Apt #3 San Rafael, California 94901 STATE OF CALIFORNIA COUNTY OF Marin County

______________________ Date

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On ____________________ before me, ________________________________, personally appeared California, proved to me on the basis of satisfactory evidence to be the person(s) whose name is subscribed to the within Affidavit and acknowledged to me that he/she executed the same in his/her authorized capacity, and who, being first duly sworn on oath according to law, deposes and says that he/she has read the foregoing Affidavit subscribed by him/her, and that the matters stated herein are true to the best of his/her information, knowledge and belief. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal.

________________________________________ (Notary Seal) Signature of Notary Public

© This is a Legal Document ©

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