Affidavit

By this deed I, the undersigned resident of Dist- previously called solemnly declare :-

1. That for and on behalf of myself and my husband, children and remitter issue, I wholly renounce/relinquish and abandon the use of my former name/surname of and in place thereof, I do hereby assume from this date the name/surname of so that I and my husband, children and remitter issue may hereafter be called, known and distinguished not by my former name/surname, but by my assumed name/surname.
2. That for the purpose of evidencing such my determination declare that I shall at all times hereafter in all records, deeds and writings and in all proceedings, dealings and transactions, private as well as upon all occasions whatsoever, use and sign the name of as my name/surname in place and in substitution of my former name/surname of .
3. That I expressly authorize and request all persons in general and relatives and friends in particular, at all times hereafter to designate and address me, my husband, my children, and remitter issue by such assumed name/surname of .
4. In witness whereof I have hereunto subscribed my former and adopted name/surname of and and affix my signature and seal, if any, this .

Signed sealed and delivered by the above name.