Affidavit for Change of Name in Birth Certificate

I. Affidavit Introduction

This Affidavit is made and executed by the undersigned individual for the sole purpose of effecting a change of name on the birth certificate issued to me. I solemnly affirm and declare the information provided herein to be accurate and true to the best of my knowledge and belief.

II. Affiant Information

A. Personal Details

• Full Name: Philip Mitchell

• Date of Birth: December 9, 2050

• Place of Birth: Milwaukee, WI 53202

• Address: Milwaukee, WI 53202

B. Identification

• Government ID Number: 80012533

• Type of ID: Driver's License

III. Birth Certificate Details

• Current Name on Birth Certificate: Phillipp Mitchells

• Proposed New Name: Philip Mitchell

• Reason for Name Change: wrong spelling and wrong last name

IV. Supporting Information

This section includes any additional details necessary to substantiate the need for the change of name, such as:

• Supporting Documents (e.g., marriage certificate, court orders, etc.)

• Any legal obligations or contracts affected by the name change

• Impact on personal records or identification

V. Declaration

I hereby declare that the facts stated herein are true, and I make this solemn declaration conscientiously, believing the same to be true and by virtue of the laws applicable to affidavits. I understand that any false statement provided in this affidavit may subject me to penalties under the law.

VI. Signature

Philip Mitchell

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