_________________________________________________
NOTICE OF NAME CHANGE
To: Rule711@illinoiscourts.gov, or
Administrative Office of the Illinois Courts
222 N. LaSalle, 13
th
Floor
Chicago, IL 60601
I hereby certify that I am licensed under Supreme Court Rule 711 under License Number
___________________. I was originally licensed under the name _________________________.
Last
________________________, ______________________. My name has changed to
________________________, ______________________, _____________________, for the
Last First Middle
Following reason: (check one)
Marriage (append copy of marriage license)
Dissolution of marriage (append copy of Judgement for
Dissolution of Marriage); or
Other (append copy of court Order)
(specify reasons for name change)
__________________________________ Dated this ______ day of ______________________, 20____
Law School Student’s Signature
For office use only:
Approved by: ___________ Date: __________
Adopted 10/20
First
Middle
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