SUFFOLK, SS. Commonwealth of Massachusetts SUPREME JUDICIAL COURT
AFFIDAVIT OF ATTORNEY NAME CHANGE
Petitioner or Attorney Current Information:
Last: __ ___ First: ___________________________ Middle: ________
Address 1: _____
Address 2: ____________________________________________________________________________
City: ____________________________ State: __________ Zip: __________ Zip Ext.: ___________
Contact Number: _____________________________ EMail: ___________________________________
Date of Petition for Admission or Date of Admission to the Massachusetts Bar:_________________________
(mm/dd/yyyy)
Attorney Registered BBO No.: ____________________________________
Former/Previous Name Information (Name provided at Petitioning to the Bar or at Admission to the Bar)
Last: __ ___ First: ___________________________ Middle: ____________
When did you change your name?
(mm/dd/yyyy)
Why did you change your Name?
*(See Secretary of the Commonwealth v. City of Lowell, 373 Mass. 178 [1977])
NOTE: If the above name change is a
result of marriage, divorce or a legal proceeding, please attach a copy of the supporting documentation (marriage certificate,
divorce decree or other Legal documentation) to this affidavit.
I, the undersigned, on Oath, depose and say that I have applied or have been admitted to the Practice of law in
the Commonwealth of Massachusetts. And this Affidavit of Name Change will record and apply the change to the
official records of the Supreme Judicial Court changing the Name:
FROM:
Last: __ ___ First: ___________________________ Middle: ________
TO:
Last: __ ___ First: ___________________________ Middle: ________
Signed under the pains and penalties of perjury. Massachusetts General Laws, Chapter 268, section 1A*
Signed: Dated:
*No written statement required by law shall be required to be verified by oath or affirmation before a magistrate if it contains or is verified by a written declaration
that is made under the penalties or perjury. Whoever signs and issues such a written statement containing or verified by such a written declaration shall be
guilty of perjury and subject to the penalties thereof if such statement is willfully false in a material matter.
2017SeptNameChangeAdvt
