Claimant Name Change Request - With Or Without Address Change (Non Assignments) (Page 2 of 2) in pdf

Claimant Name Change Request Instructions (Non Assignment)

Depending on the reasons for your name change, you may need to also submit one or more of the following forms:

Divorce Affidavit

Name-Address Estate under 5000 Affidavit

Name-Address Inactive or Dissolved Company Affidavit

Name-Address Inactive or Dissolved Company Estate Affidavit

Support documents, as specified below, must accompany your request. All supporting documents must contain the

new information entered on the change form. The Receiver reserves the right to validate any name and/or address

change request received and may request additional information from you. Please contact us if you have questions by

clicking on the “Contact Us Form” in the website’s

navigation pane or you may call

Consumer Services at 800-882-3054.

Claimant Name Change

Name Change due to Marriage (with or without address change). Please complete the

Request Form With or Without Address Change

and send it in with one of these documents:

 Copy of valid driver’s license

 Utility bill

 Passport, or other photographic legal identity document

 Copy of marriage certificate.

Claimant Name Change

Name Change due to Death (with or without address change). Please complete the

Request Form With or Without Address Change

and send it in with these documents:

 Copy of valid driver license or other photographic legal identity document for individual requesting name

change.

 Copy of death certificate.



Name-Address Estate under

If the total amount of the claim is less than $5,000, a properly executed

5000 Affidavit

 If the total amount of the claim is more than $5,000, a certified copy of court order identifying beneficiaries,

or documents from probate that reflect this information, copy of will and Petition for Discharge or

appointment of personal representative.

Claimant Name Change

Name Change due to Divorce (with or without address change). Please complete the

Request Form With or Without Address Change

and send it in with one of these documents:

 Copy of valid driver license, utility bill, passport, or other photographic legal identity document.

 Copy of divorce agreement.

 A properly executed

Divorce Affidavit

Name Change for Active Companies or Corporations (with or without address change). Please complete the

Claimant Name Change Request Form With or Without Address Change

and send it in with these documents:

 Copy of valid driver license or other photographic legal identity document for individual requesting name

change.

 If incorporated, copy of most recent filing with Sec of State ( ), or filing that reflects name

change.

 If not listed with Sec of State submit signed statement by a listed officer authorizing payment, Corporate

bylaws reflecting authorization or Corporate resolution reflecting individual’s authority to act on behalf of

company.

Name Change for Inactive or Dissolved Companies or Corporations (with or without address change). Please

Claimant Name Change Request Form With or Without Address Change

complete the

and send it in with

these documents:

 A copy of valid driver license or other photographic legal identity document for individual requesting name

change.

 Documentation that will clearly verify the connection between the individual and the dissolved company or

corporation, such as Tax Filings, occupational license, bank statements, etc.

 If incorporated, a copy of last filing with Sec of State ( ) identifying officers.

 If not listed with Sec of State, submit signed statement by a listed officer authorizing payment or corporate

bylaws reflects authorization or corporate resolution authorizing Receiver to conduct a Bankruptcy Search

to confirm no creditors exist for dissolved company.

 A properly executed

Name-Address Inactive or Dissolved Company Affidavit



Name-Address Inactive or Dissolved Company Estate

If owner deceased, a properly executed

Affidavit

Claimant Name Change Request - With Or Without Address Change (Non Assignments) Page 2

Related Articles

Related forms

Related Categories