Affidavit Change Of Attorney Name

Supreme Court of the State of New York Appellate Division: Second Judicial Department AFFIDAVIT CHANGE OF ATTORNEY NAME State of _________________ ) County of ______________________________) s.s.: _________________________________________________________, deposes and says that: being duly sworn, 1. I was admitted to the practice of law by the Appellate Division, Second Department, on ________________, under the name of __________________________________________. 2. I now seek permission to change the name under which I practice law to ________________________________________________. 3. I have not been known by any other names. (strike one) I have been known by the following other names: 4. I seek to change the name under which I practice law for the following reason: ____ ____ My name has been changed by court order pursuant to Civil Rights Law § 63 (attach a certified copy of the court order authorizing the name change). My surname has changed by reason of marriage pursuant to Domestic Relations Law §§ 14 and 15(1)(b) and Civil Rights Law § 65(1) (attach a certified copy of your certificate of marriage registration setting forth your changed marital surname). My surname has changed by reason of a divorce or an annulment of a marriage pursuant to Domestic Relations Law § 240-a and Civil Rights Law § 65(2) (attach a certified copy of your judgment of divorce or annulment authorizing the resumption of use of a surname by which you were known prior to marriage). ____ 5. I am in good standing at the bar, in that I am not disbarred or suspended from practice, I am duly registered with the Office of Court Administration, and I am current in the payment of the biennial registration fee. American LegalNet, Inc. www.FormsWorkFlow.com 6. I am not currently subject to a pending disciplinary investigation and to my knowledge there are no complaints of professional misconduct filed against me. 7. No previous application to change the name under which I practice law has been made (except as follows). WHEREFORE I request that the name under which I am authorized to practice law as recorded on the Roll of Attorneys and Counselors-at-Law on file in the office of the Clerk of this court be changed as set forth above. Dated: ___________________ ____, 20___ ___________________________________ Signature Sworn to before me this ________ day of _____________________, 20___ __________________________________ Street Address __________________________________ City, State, Zip __________________________________ Phone Number _________________________________ Notary Public American LegalNet, Inc. www.FormsWorkFlow.com