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(For use with banks, credit cards, utility companies and other financial records)

Company Name:

Address :

City:                       State:                   Zip Code:             

Please be advised that the following client record has had a change of name.

Current name on account:

Account #:

Reference:

Please change the current name on the account to reflect the client's new married name.

New Name :

Address:

City:                       State:                   Zip Code:             

(Check all that apply)

___ The above reflects a new change of address.

___ I request a "Change of Beneficiary Form." (if applicable)

I authorize you to make the above referenced record change. If you have any further questions regarding this matter please call me at: ________________ (phone number).

Sincerely,

_____________________ ___________

(Sign name here)                          (Date)

_____________________

(Print name here)

Enclosure: Photocopied Certificate of Marriage