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Get MN BLE Change of Name Notification

Urt Order. CHANGE OF NAME NOTIFICATION Complete this Form to notify the Board of your name change AFTER you submit your application. Date Form Completed: Effective Date: CURRENT Name: Current Full Name: Mr./Ms. LAST Name FIRST Name MIDDLE Name LAST Name FIRST Name MIDDLE Name NEW! Name: NEW! Full Name: Mr./Ms. Date of Birth: Signature: Date: SIGNATURE REQUIRED! mm/dd/yyyy You MUST mail this form to the Board office along with a copy of your Marriage Certificate or Court Order. You.

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