Minnesota > Statewide > District Court > Name Change
Inmate Affidavit For Name Change NAM-105 - Minnesota
| Inmate Affidavit For Name Change Form. This is a Minnesota form and can be used in Name Change District Court Statewide . |
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State of Minnesota County Judicial District: Court File Number: Case Type: District Court Name Change In the Matter of the Application of: First Middle Last For a change of name to: Inmate Affidavit for Name Change (Minn. Stat. ยง 259.12) Last First Middle I, under oath: , the applicant in this matter, make the following statement I am currently an inmate confined in a correctional facility, as defined in section 241.021, subdivision 1, clause (5). I have not at any time during my confinement requested a name change under section 259.10, other than this request. The reason I am seeking a name change is: I request the court to issue its Order Granting Name Change. Dated: Signature (Sign only in front of notary public or court administrator.) Name: Sworn/affirmed before me Date: Notary Public \ Deputy Court Administrator Address: . City/State/Zip: Telephone: ( ) NAM105 State ENG Rev 4/01 www.courts.state.mn.us/forms Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com
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