Fillable Change of Name Form New Jersey Ofce of (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Change of Name Form New Jersey Ofce of (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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The Change of Name Form New Jersey Ofce of (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General) form is 1 page long and contains:

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  • 10 other fields

Country of origin: US
File type: PDF

U.S.A. forms for State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General

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New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Social Work Examiners
124 Halsey Street, 6th Floor, P.O. Box 45033
Newark, New Jersey 07101
(973) 504-6495
www.njconsumeraffairs.gov/sw
Change of Name Form
Please print clearly.
Please Note: You must submit proof of legal name change in the form of a marriage license,
divorce decree, or a court order. Maiden names may not be used as middle names without a
court order.
Name: ______________________________________________________________________
License number: ______________________________________________________________
Address: ____________________________________________________________________
Street
____________________________________________________________________________
City State ZIP code
Telephone number: ________________________ E-mail: _____________________________
Include area code
New name: __________________________________________________________________
Request a new license - If you would like to have a new license/certicate to reect the name
change, please return the original license/certicate with your former name. If you do not return
the original license/certicate, a fee of $ 25.00 would be required for a duplicate license/
certicate.
Signature: ____________________________________ Date: __________________________
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Change of Name Form New Jersey Ofce of (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Completed 15 August 2020

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