USLF Form 9087
M ASSACHUSETTS
N AME CHANGE PACKAGE
Published by:
U.S. Legal Forms, Inc.
http://www.uslegalforms.com
This package is for use after you have changed your
name to notify companies, government organizations and
others of the change. This package is for persons who
have changed their name by marriage, divorce, or court
order.
Includes instructions and forms for changing your records, including, your
(1) Social Security Card, (2) Driver’s License and Vehicle Title, (3)
Passport, (4) Post Office, (5) IRS and State Tax Commission, (6) Banks,
(7) Credit Cards, (8) Doctors (9) Insurance Companies, (10) Clubs,
Organizations and other like entities, (11) Employer, (12) Will, Contracts
and (12) Retirement plans, as well as others.
Disclaimer: If you have a serious legal problem, you are advised to seek the
advice of an attorney. Some forms are official forms and may be in .pd f format,
which require the free Adobe Acrobat Reader for printing, available for
downloading at http://www.adobe.com.
USLF Form 9087 TABLE OF CONTENTS
FORM NAME FORM NUMBER
Social Security Card 9087-A
Passport Change of Name 9087-B
U.S. Passport Office Authorization Form 9087-C
Post Office Change of Name 9087-D
Notice of Name Change for Clubs, Organizations, Etc. 9087-E
Notice of Name Change for Banks and Other Financial Institutions 9087-F
Notice of Name Change for Internal Revenue Service and State Tax Commission 9087-G
Notice of Name Change for Utilities-Electric, Phone, Gas, Etc. 9087-H
Notice of Name Change for Employer 9087-I
Voter Registration 9087-J
Notice of Name Change for Landlord 9087-M
Notice of Name Change for Insurance Companies 9087-N
Notice of Name Change for Doctors 9087-O
Department of Motor Vehicles Change of Name on Driver’s License 9087-P
Will, Trust, Power of Attorney, Living Will, Health Care Proxy, etc. 9087-Q
Notice of Name Change for Will, Trust, Power of Attorney, Living Will,
Health Care, Proxy, etc. 9087-R
USLF Form 9087-A SOCIAL SECURITY CARD
You may obtain a new social security card as a replacement by using official form SS-5.
You may also change your name on your card by using the same official form. The card
number will remain the same.
To get a replacement card, you usually need one identifying document. Some documents
that Social Security Offices may accept as proof of identity are: 1. Driver’s license
2. Marriage or divorce record
3. Military records
4. Employer ID card
5. Adoption record
6. Insurance policy
7. Passport
8. Health Insurance card (not a Medicare card)
9. School ID card
For a name change on your card, you need documentation that shows your old name and
your new name.
Your new card will show your new name but will have the same number as your old c ard.
NOTE: Social Security Offices cannot accept photocopies of documents. You must su bmit
original documents or copies certified by the custodian of the record. Notarized c opies are
not acceptable.
How to Obtain the Form
To download the SS-5 form (in .pdf format), click on the following link:
http://www.ssa.gov/online/ss- 5.pdf
You must have the Adobe Acrobat Reader software to view the form. If you do not already
have this special software, it can be easily and quickly downloaded here:
http://get.adobe.com/reader/
How to Complete the Form
Complete the SS-5 using the instructions on pages 1 and 6 of the form. See page s 2 and 3
of the form for the evidence that you will need to submit with your applic ation.
Where to Send the Form
Finally, take or mail the SS-5 to the nearest Social Security office. Be sure to take or mail
the originals or certified copies of your supporting documents along wit h the form. Your
Social Security Office will return your original documents right away. Once Social Security
ha s everything they need, they will send your Social Security Card in about two week s.
If you are not sure where your local office is located, call 1- 800-772 -1213
USLF Form 9087-C PASSPORT CHANGE OF NAME
The form required is form DS- 5504, to be used within one year of passport issuance for
name-changes, other information changes and extension of limited pass ports. If more than
one year has passed, you must apply for a new passport. You may obtain this form from a
post office or county clerk's office, or you may print the appli cation form directly from the
link provided in this package.
The form you submit must be clear and sharp. Applications that are blurre d or illegible will
not be accepted. They must be printed in black print on white pap er. The paper must be 8
1/2 inches by 11 inches, with no holes or perforations, at least medium (20 lb.) weight, and
with a matte surface. Thermal paper, dye-sublimation paper, special inkj et paper, and other
shiny papers are not acceptable. Faxed DS forms are not acceptable.
This form is for applicants who need to:
Change printed information in a passport (i.e. name change), OR
Extend the validity of a 1-year, limited passport, OR
Add additional visa pages to a valid passport (use form DS-4085).
The following items are needed to effectuate the change: 1. Current valid passport.
2. Original DS-5504 (Re-Application) or DS-4085 (Additional Visa Pages)
3. Certified copy of Legal Instrument that shows a name change. For example:
Marriage Certificate, Divorce Decree or other. (Whatever maybe the case).
4. Proof of departure in a copy of your itinerary from your travel agent or airline
or copy of your plane ticket showing departure date and destination.
DS -5504 (Re-Application) or DS-4085 (Additional Visa Pages)
To download form DS-5504 (Re-Application) or DS-4085 (Additional Visa Pages) in .pdf
format:
http://travel.state.gov/passport/forms/ds5504/ds5504_2663.html
http://travel.state.gov/passport/forms/ds4085/ds4085_2662.html
You need the Adobe Acrobat Reader software to view this and other .pdf format forms. If
you do not already have this special software, it can be easily and quickly downloaded here:
http://get.adobe.com/reader/
Other Passport related forms may be downloaded from the following links:
Application for a U.S. Passport:
http://travel.state.gov/passport/forms/ds11/ds11_842.html
Application for a U.S. Passport by mail:
http://travel.state.gov/passport/forms/ds82/ds82_843.html
Replacing a lost or stolen Passport (DS-0011 also required):
http://travel.state.gov/passport/forms/ds64/ds64_845.html
USLF Form 9087-C U. S. PASSPORT OFFICE AUTHORIZATION FORM
To Whom It May Concern:
I, ______________________________, do hereby authorize ________________________
__________________ or any other agent from _________________________________ to
receive my passport or discuss the status of my application with a member of the Passport
Office Staff.
Thank you for your assistance.
________________________
Signature
Date ____________________
USLF Form 9087-D
POST OFFICE CHANGE OF NAME
You are not required to change your name at a post office. However, it is
important to do a change of address if you also have a new address. You
may locate a change of address packet at your local post office. You may
also complete a form on-line and submit it to the post office by using the
following link. Copy this link into the address window of your Internet
browser.
https://moversguide.usps.com/icoa/flow.do?_flowExecutionKey=_c
DE7B2494-88BC-3D7D- 2875-706A430AD3AF_k399D1FE5-B06A-
596E-3C90-71D9BB67C8A7
The form allows you to enter your change of address information and then print your completed Change of Address Form. You may also include your
new name, on the change of address form. You will then need to sign the
form and either give it to your letter carrier or mail it to your local post
office.
If you do not desire to use the on-line form, you may pick up a Mover's
Package from your local post office.
USLF Form 9087-E – Clubs, Organizations, Etc.
N OTICE OF NAME CHANGE
To: Date:
Address:
City: State: Zip:
ID Number, if applicable:
From (new name):
Current Address:
City: State: Zip:
Social Security Number:
My Former Name:
My Present (New) Name:
To Whom It May Concern:
This notice is provided to advise you that I have changed my name to the
new name as provided above. Please change all records to my new name.
The reason for the name change is: ( ) Marriage
( ) Divorce and resumption of my maiden name.
( ) Name Change Court Order not connected with divorce.
( ) Other: _______________________________________
Please let me know if you need anything else.
Sincerely yours,
______________________
Signature (New Name)
______________________
Signature (Former Name)
USLF Form 9087-F – Banks
N OTICE OF NAME CHANGE
To: Date:
Address:
City: State: Zip:
Account or Loan Number:
Account or Loan Number:
Account or Loan Number:
From (new name):
Current Address:
City: State: Zip:
Social Security Number:
My Former Name:
My Present (New) Name:
To Whom It May Concern:
This notice is provided to advise you that I have changed my name to the
new name as provided above. Please change all records to my new name.
My address above: ( ) is, ( ) is not, a new address.
The reason for the name change is: ( ) Marriage
( ) Divorce and resumption of my maiden name.
( ) Name Change Court Order not connected with divorce.
( ) Other: _______________________________________
Please let me know if you need anything else.
Sincerely yours,
______________________
Signature (New Name)
______________________
Signature (Former Name)
USLF Form 9087-G - Internal Revenue Service and State Tax Commission
N OTICE OF NAME CHANGE
To: Date:
Address:
City: State: Zip:
Account Number:
From (new name):
Current Address:
City: State: Zip:
Social Security Number:
My Former Name:
My Present (New) Name:
To Whom It May Concern:
This notice is provided to advise you that I have changed my name to the
new name as provided above. Please change all records to my new name.
The reason for the name change is: ( ) Marriage
( ) Divorce and resumption of my maiden name.
( ) Name Change Court Order not connected with divorce.
( ) Other: _______________________________________
Please let me know if you need anything else.
Sincerely yours,
______________________
Signature (New Name)
______________________
Signature (Former Name)
USLF Form 9087-H – Utilities: Electric, Phone, Gas, Etc.
N OTICE OF NAME CHANGE
To: Date:
Address:
City: State: Zip:
Account Number, if known:
From (new name):
Current Address:
City: State: Zip:
Social Security Number:
My Former Name:
My Present (New) Name:
To Whom It May Concern:
This notice is provided to advise you that I have changed my name to the
new name as provided above. Please change all records to my new name.
The reason for the name change is: ( ) Marriage
( ) Divorce and resumption of my maiden name.
( ) Name Change Court Order not connected with divorce.
( ) Other: _______________________________________
Please let me know if you need anything else.
Sincerely yours,
______________________
Signature (New Name)
______________________
Signature (Former Name)
USLF Form 9087-I - Employer
NOTICE OF NAME CHANGE
To Employer: Date:
Address:
City: State: Zip:
From (new name):
Current Address:
City: State: Zip:
Social Security Number:
My Former Name:
My Present (New) Name:
To Whom It May Concern:
This notice is provided to advise you that I have changed my name to the
new name as provided above. Please change all records to my new name.
The reason for the name change is: ( ) Marriage
( ) Divorce and resumption of my maiden name.
( ) Name Change Court Order not connected with divorce.
( ) Other: _______________________________________
Please let me know if you need anything else.
Sincerely yours,
______________________
Signature (New Name)
______________________
Signature (Former Name)
USLF Form 9087-J VOTER REGISTRATION
Depending on your state, you may change your voter registration at your city, tow n hall, or at the
same time you change your driver’s license number at the Department of Motor Vehicles
(DMV). You can also register to vote when applying for services at State offices provi ding State-
funded programs for the disabled, and at armed forces recruitment offices. In addition to these
locations, many States offer registration opportunities at public librarie s, post offices,
unemployment offices, public high schools and universities.
The National Mail Voter Registration Form is the one document that a llows you to register to
vote from anywhere in the United States.
The National Form can be used to: - Register out-of-town tourist and convention groups.
- Register people from surrounding States who work, shop, or attend events in a central city.
- Conduct voter registration drives, especially at colleges and universities.
- Register individuals at State agencies or other public offices.
Please Note the Following Exceptions:
- New Hampshire town and city clerks will accept this application only as a reque st for
their own mail-in absentee voter registration form.
- North Dakota does not have voter registration.
-Wisconsin town, village, and city clerks will accept this application only as a re quest for
their own mail-in registration form.
- Wyoming cannot accept this form under State law.
The following States will accept copies of this application printed from the co mputer image on
regular paper stock, signed by the applicant and mailed in an envelope with the correct post age:
Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Hawaii, Iow a,
Kansas, Louisiana, Maryland, Michigan, Minnesota, Montana, Nebraska, New Jersey, New
York, Oklahoma, Pennsylvania, South Carolina, Texas, Utah, Washington, West Virginia, and
Wisconsin.
For the remainder of the States which do not accept copies of the National Mail Voter
Registration Form, you may obtain a State voter registration form by a written request mai led to
the address of the State election office listed in the State Instructions.
You may access voter registration requirements for all states – use this link:
http://www.eac.gov/files/voter/nvra_update.pdf
For further information, see the table on the next page.
USLF Form 9087-J
State Change Allowed
at Department of
Motor Vehicles
Mail in
Allowed
Massachusetts Yes Yes
Notes: Massachusetts residents may register to vote via a
mail-in registration form. The completed form must be mailed
to the local city or town hall. The applicant should receive a
confirmation notice within 2 to 3 weeks.
More information on voter registration may be found at:
http://www.sec.state.ma.us/ele/eleifv/howreg.htm
Mailing Address: Secretary of State
Elections Division
McCormack Building, Room 1705
One Ashburton Place
Boston, MA 02108
Telephone: (617) 727 -2828
Toll-Free: 1-800-462-VOTE
USLF Form 9087-M - Landlords
N OTICE OF NAME CHANGE
To Landlord: Date:
Address:
City: State: Zip:
Address of Premises Leased:
From (new name):
Current Address:
City: State: Zip:
Social Security Number:
My Former Name:
My Present (New) Name:
To Whom It May Concern:
This notice is provided to advise you that I have changed my name to the
new name as provided above. Please change all records to my new name.
The reason for the name change is: ( ) Marriage
( ) Divorce and resumption of my maiden name.
( ) Name Change Court Order not connected with divorce.
( ) Other: _______________________________________
Please let me know if you need anything else.
Sincerely yours,
______________________
Signature (New Name)
______________________
Signature (Former Name)
USLF Form 9087-N – Insurance Companies
NOTICE OF NAME CHANGE
To Insurance Company: Date:
Address:
City: State: Zip:
Policy Number: Plan Number, if applicable:
From (new name):
Current Address:
City: State: Zip:
Social Security Number:
My Former Name:
My Present (New) Name:
To Whom It May Concern:
This notice is provided to advise you that I have changed my name to the
new name as provided above. Please change all records to my new name.
The reason for the name change is: ( ) Marriage
( ) Divorce and resumption of my maiden name.
( ) Name Change Court Order not connected with divorce.
( ) Other: _______________________________________
Please let me know if you need anything else.
Sincerely yours,
______________________
Signature (New Name)
______________________
Signature (Former Name)
USLF Form 9087-O - Doctors
N OTICE OF NAME CHANGE
To: Dr. Date:
Address:
City: State: Zip:
Patient ID if known:
From (new name):
Current Address:
City: State: Zip:
Social Security Number:
My Former Name:
My Present (New) Name:
Dear Doctor:
This notice is provided to advise you that I have changed my name to the
new name as provided above. Please change all records to my new name.
The reason for the name change is: ( ) Marriage
( ) Divorce and resumption of my maiden name.
( ) Name Change Court Order not connected with divorce.
( ) Other: _______________________________________
Please let me know if you need anything else.
Sincerely yours,
______________________
Signature (New Name)
______________________
Signature (Former Name)
USLF Form 9087-P DEPARTMENT OF MOTOR VEHICLES
C HANGE OF NAME ON DRIVER ’S LICENSE
To change your name on your driver’ s license, you will need to complete
state specific forms usually provided from the Department of Motor Vehicles.
Most states require that you appear in person to change the name on your
driver’s license so that a new license can be issued. You can check the
information below to see if your state allows you to change your name on
your license by mail.
In order to change your license, you will need to present proof of the
change. Proof of the change can be a certified copy of your marriage license,
certificated copy of your divorce judgment containing the provision allowing
you to reclaim your maiden name, or a certified copy of the Court order
changing your name. Certified copies can be obtained from the office that
issued the marriage license or the court clerk that issued the divorce decree
or name change order.
You will also need to present your present license. You may desire to
present your social security card, or password as additional proof of
identification.
Some Departments of Transportation also allow you to change your voter
registration at the same time you change your license by completing
additional forms.
Massachusetts http://www.massdot.state.ma.us/rmv/
Form Information:
Notes: If an individual changes his or her name, it must be reported to the
Registry of Motor Vehicles so that the driver’s license and records can be
updated. There is a $15 charge for obtaining a new driver’s license and this
transaction must be done in person at a branch office.
Phone Number: 1- 617-351- 4500
USLF Form 9087-Q Will, Trust, Power of Attorney, Living Will, Health Care Proxy, etc.
Whether you changed your name by marriage, divorce or otherwise you will want to update
or change your Will, Trusts, Power of Attorney, Living Will, Health Care Pr oxy and other
legal documents.
Divorce or Marriage is a time to make a will if you do not have one, or to make a new will
because your circumstances have changed. This name change guide does not include forms
for a will. You may locate one to fit your needs at:
http://www.uslegalforms.com
This package does contain forms to amend legal documents to reflect your name change, as
evidence of the change. These forms do not change the legal content of a ny of those legal
documents.
If you do not have any of the legal documents identified, this may be a good time to
consider whether you are in need of any of these documents.
The form provided is to be attached to your legal document. See next page for t he form.
USLF Form 9087-R Notice of Name Change
NOTICE is hereby provided that _____________________________ (former
name) has changed his/her name to _____________________________,
due to ( ) marriage, ( ) divorce, ( ) Court Order, or ( ) Other:
________________________________. The change is effective as of the
____ day of _______________, 20___.
Prior to the name change, I entered into or executed the following
document:
Title of Document: ____________________________
Date of Document: ____________________________
Subject Matter of Document: ________________________________ ________________________________________________________
This Notice of Name Change is merely a Notice to all interested persons that
the above document remains in full force and effect and that
_________________________ (former name) is one and the same person
as _________________________ (new name).
DATED this the _______ day of ___________________, 20___.
________________________________
Signature (Former Name)
________________________________
Signature (New Name) ---- ---------------------------------Notary, If Required------- ----------------------------------
STATE OF __________________ County of ____________________
The above Notice was SWORN TO AND SUBSCRIBED before me on this the _______ day of
________________ ___, 20______, by ___________________________ aka
____________________________________. (Name aka Name)
_________________________________
Notary Public
My Commission Expires:
______________________