Fillable JODY PHILLIPS DUVAL COUNTY CLERK OF THE CIRCUIT (Duval County Clerk of Courts)

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JODY PHILLIPS DUVAL COUNTY CLERK OF THE CIRCUIT (Duval County Clerk of Courts)

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JODY PHILLIPS
DUVAL COUNTY CLERK OF THE CIRCUIT COURT
DOMESTIC RELATIONS DEPOSITORY
CHANGE OF NAME
501 West Adams Street
Jacksonville, Florida 32202
Fax: 904-255-2392
Please complete this form and mail or fax it back. Please print.
Your Name:
Your SSN:
Your Case No:
Daytime Telephone Number:
Your Old Name:
Your New Name:
Change of name forms will not be processed unless this form is completed in full. In
addition the Domestic Relations Depository requires a copy of a picture ID (drivers
license).
I authorize the Duval County Domestic Relations Depository to change my name.
Signed:
Date:
(Please attach copy of picture Id here)
DOB:____________________________
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JODY PHILLIPS DUVAL COUNTY CLERK OF THE CIRCUIT (Duval County Clerk of Courts)

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Completed 9 January 2021

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