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)S.S.
AFFIDAVIT OF
UNDERTAKING TO CHANGE NAME
3. This Affidavit is executed to attest to the truth of the foregoing and for whatever
legal purpose and intent it may serve.
__________________
Affiant
[SIGNATURE]
[NAME]_______
Notary Public
Until [DATE]__________________
PTR No. [NUMBER] ____________
Issued at [PLACE]______________
On [DATE] ___________________
Doc. No.
Page No.
Book No.
Series of [YEAR] ___________.