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H St. Des Moines, Iowa 50319-0147 Rev 5/11 I. TO BE COMPLETED BY APPLICANT (type or print) Please allow four weeks for processing. Name changes require a photocopy of official legal documentation. All fees are NONREFUNDABLE. Incomplete applications will be voided after 45 days. Applicant s Folder # Social Security # Date of Birth Month Day Male Female Year Last Name First Name Middle Name Maiden Name Address City State Zip Code Evening Phone ( ) Daytime Phone ( ) Email Address.

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