Get Affidavit For Name Change

Completing the affidavit for name change is an essential step for individuals seeking to update their name associated with their nursing license. This guide will provide clear, step-by-step instructions to ensure a smooth and efficient process while filling out this document online.

Follow the steps to successfully complete your affidavit for name change.

1. Press the ‘Get Form’ button to access the affidavit for name change. This will open the document in your preferred editor.
2. Begin filling in your current name as it appears on your nursing license. Enter your first, middle, maiden, and last names in the designated fields.
3. In the section provided, input the requested name change which you wish to associate with your nursing license. Again, fill in each name component: first, middle, maiden, and last.
4. Next, enter your Social Security number, followed by your mailing address. Include the PO Box or street address, city, state, zip code, and county.
5. Fill in your nursing license number, ensuring that it is accurate to avoid complications.
6. Identify your primary state of residence by indicating the state name in the appropriate field.
7. If you are requesting a name change, attach a copy of the legal document that supports your name change, such as a marriage license or divorce decree.
8. Remember that the completed form must be notarized. Make arrangements to verify your identity with a notary public.
9. Finally, return the notarized form to the Mississippi Board of Nursing along with the non-refundable fee of $25. Payment can be made by check or money order payable to the Mississippi Board of Nursing.

Complete your affidavit for name change online today and ensure your nursing license reflects your current name.