Fill and Sign the County Clerks Office Wyoming Secretary of State Form

-1- IN THE DISTRICT COURT JUDICIAL DISTRICTSTATE OF WYOMINGCOUNTY OF In the Matter of the Change of Name of) ) ) ) ) ) CASE NO. ))) AFFIDAVIT STATE OF WYOMING ) ) SS COUNTY OF ) and , having been first duly sworn according to law, on oath deposes and states as follows: 1.That he/she/they are the Petitioners in the above-entitled matter in which Petitioners seek to change his/her/their names as follows: FromTo 2. Petitioners’ and minor children’s name(s), age(s) and place(s) of residence are:Name: Age: Address: -2- Name: Age: Address: Name: Age: Address: Name: Age: Address: Name: Age: Address: 3. That the Petitioner(s) and minor child(ren) are currently a resident of County, Wyoming.4.That the Petitioner(s) and minor child(ren) have been an actual bona fide resident of County, Wyoming for two years preceding the filing of this petition. 5. That the Petitioners desire this change of name for the following reason: . DATED this day of , 20 . Petitioner Type or Print Name -3- Petitioner Type or Print NameSTATE OF WYOMING ) ) SS COUNTY OF ) THE FOREGOING AFFIDAVIT was subscribed and sworn to before me by and , this day of , 20 . Notary PublicMy commission expires: Type or Print Name