BY THIS DEED OF CHANGE OF NAME made by myself the undersigned of , in the County of formerly known as , .
HEREBY DECLARE AS FOLLOWS:
I ABSOLUTELY and entirely renounce, relinquish and abandon the use of my said former name and assume, adopt and determine to take and use from the date hereof the name of in substitution for my former name of .
I SHALL AT ALL TIMES hereafter in all records, deeds documents and other writings and in all actions and proceedings as well as in all dealings and transactions and on all occasions whatsoever use and subscribe the said name of as my name, in substitution for my former name of so relinquished as aforesaid to the intent that I may hereafter be called known or distinguished not by the former name of but by the name .
I AUTHORISE AND REQUIRE persons at all times to designate, describe, and address me by the adopted name of .
IN WITNESS whereof I have hereunto subscribed my adopted and substituted name of and also my said former name of .
SIGNED AS A DEED THIS DAY OF IN THE YEAR .
|By the above named|
In the presence of