Membership Records Name Change Form

THE STATE BAR OF NEVADA Member Services Department Membership Records Name Change Form Please CLEARLY PRINT your previous name: Me mber Bar Number: Previous L ast Name: Previous First Name Previous Middle Name : Second Midd le Name: Signature under this name: Please CLEARLY PRINT your new name: Ne w Last Name: New First Name New Middle Name: Second Middle Name: Signature under this name: Please provide a phone number o r email for questions regarding this request: Questions ? (702) 382 - 2200 Completed f orms and documentation may be emailed to: memberservices@n vbar .org or m ailed t o: State Bar of Nevada Member Services 3100 W. Charleston Blvd. , Suite 100 Las Vegas, NV 89102 To change an official name your request must be accompanied by one (1) copy of an official legal document showing the requestors new name. Examples of acceptable identity documents include photocopies of marriage license, divorce decree, passport , or driver s license . FOR SBN USE American LegalNet, Inc. www.FormsWorkFlow.com