Legal Name Affidavit

I. Affiant's Personal Information

1. Full Name: Katherine Connor

2. Date of Birth: January 15, 1990

3. Address: Miami, FL 33103

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II. Statement of Intent

The undersigned, being duly sworn, hereby declares under oath that the information provided in this affidavit is accurate and truthful to the best of their knowledge and belief. This affidavit is made to confirm the legal name for all intended legal purposes.

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III. Name Declaration

A. Current Legal Name

1. First Name: Katherine

2. Middle Name: Elizabeth

3. Last Name: Connor

B. Previous Name(s)

1. Name as it appears on Birth Certificate: Katherine Elizabeth Connor

2. Other previously used names:

   • First Previous Name: Katherine E. Connor

   • Second Previous Name: Katie Connor

   • Additional Names: None

C. Reason for Name Change
The purpose for any name change(s) or discrepancies, if applicable, are as follows:

• Marriage

• Divorce

• Legal Name Change Petition

• Other: None

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IV. Additional Information

Provide any additional information relevant to the legal name status or changes that might aid in confirming identity:

• No additional information available.

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V. Declaration of Truthfulness

I hereby affirm that the information contained within this affidavit is accurate and complete. I understand that any false statement or omission may be punishable by law.

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This document is a mock example and not legally binding. For actual legal purposes, it’s essential to consult with a legal professional.

VI. Signature

Katherine Connor

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