name change by 8jkO3F3s

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									                      WHITMAN COUNTY

                  Human Resources
                  WHITMAN COUNTY COURTHOUSE
                   COLFAX, WASHINGTON 99111




            CHANGE OF NAME/ADDRESS/PHONE NUMBER
Name               _______________________________________

Social Security    _______________________________________



NAME CHANGE:

Old Name      ____________________________________________

New Name      ____________________________________________


ADDRESS CHANGE:

Old Address    ___________________________________________
               ___________________________________________

New Address ___________________________________________
            ___________________________________________


PHONE NUMBER CHANGE:

Old Phone Number ______________________________________

New Phone Number ______________________________________


I certify that my Name/Address/Phone number was changed as shown above.


____________________________________               __________________
Signature                                          Date

								
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