Application For Change Of Name Certificate
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1CHRIS DANIEL
HARRIS COUNTY DISTRICT CLERK
APPLICATION FOR CHANGE OF NAME CERTIFICATE
As provided in Section 45.106, Family Code, the undersigned person applies to the District Clerk
for a change of name certificate.
Cause Number: _________________________ Court Number: ____________________________
Driver’s License Number: ____________________________________________________________
Social Security Number: _____________________________________________________________
Signature of Applicant: ______________________________________________________________
CHANGE OF NAME CERTIFICATE
Name of person before change of name was ordered:
__________________________________________________________________________________
Name to which the person’s name was changed by the court:
__________________________________________________________________________________
DATE NAME CHANGE ORDERED: __________________________________________________
DRIVER’S LICENSE NUMBER: _____________________________________________________
SOCIAL SECURITY NUMBER: ______________________________________________________
I, CHRIS DANIEL, Harris County District Clerk, hereby certify a name change was granted as
reflected above.
________________________
By: ___________________________________________
Date
Deputy District Clerk
S:\FormsLib\Civil Bureau\Civ Fam Intake & Customer Svc\Customer Service\Application for Change of Name Certificate
Revised 11/18/08
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