NAME CHANGE

Name change is processed with writen request to include a copy of marriage license, divorce papers, birth certificate or court papers and a copy of your driver license. Fax to 210 733-2579 or mail to 1300 San Pedro, SA TX 78212.  Documents will not be processed without proper documentation and signature.

State law requires that you be informed of the following:  (1) you are entitled on request to be informed about the information that is collected about you by use of this form (with few exceptions as provided by law); (2) you are entitled to receive and review the information; and (3) you are entitled to have information corrected at no charge to you.
 
SSN: Date of Birth:  
Date:
Former name:
Last First
Current name:
Last First
E-mail address Phone number
Type of legal document submitting:
Birth certificate
 Divorce papers Marriage license
   
Signature: _____________________________________________
Do not write below this line
       
Date Changed: ________ Initials: ______ Instructor: ________ Class section: _______ Date Notified: ________ Initials ______
Date last updated 9/22/06