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Pennsylvania if applicable) _________________________________ _________________________________ (Name) _________________________________ (Position, if applicable) ies have caused this Amendment to be executed the day and year written above. ________________________________ ___________________________________ (Name) ___________________________________ (Position,nants and conditions contained in this Amendment shall apply to and bind the parties and the heirs, legal representatives, successors and permitted assigns of the Parties. IN WITNESS WHEREOF, the parthe term of the Contract except for those provisions of the Contract that are directly contradicted by this Amendment, in which event the terms of this Amendment shall control. BINDING EFFECT: The cove_________________________________________ ________________ OTHER TERMS OF THE CONTRACT: The Parties agree that all other terms, conditions and obligations of the Contract remain in effect throughout t__________ ____________________________________________________________________________ ____________________________________________________________________________ ___________________________________________________________________________________________ ____________________________________________________________________________ __________________________________________________________________exhibit to this document] ____________________________________________________________________________ ____________________________________________________________________________ ____________________d WHEREAS, the Parties wish to amend the Contract. NOW, THEREFORE, the Parties hereby agree as follows: AMENDMENT: The Contract is amended as follows: [Describe the amendment below or attach it as an ies." WHEREAS, the Parties entered into an agreement dated ________________, 20__ regarding ___________________________________________________________ ___________________________ (the "Contract"); an ____________________, 20____ by and between ________________________________________ and ____________________________________________________________, who may collectively be referred to as the "Part___) ________-______________. Thank you for your prompt attention to this matter. Yours Truly, [Insert your name] AMENDMENT TO CONTRACT This Amendment to Contract (the "Amendment") is entered as of_________ ______________________________________________________________________ If you have any questions or need additional information or documentation, please do not hesitate to contact me at (___ that I have recently been divorced and have changed my name. The current name on my account is: _________________________[insert name] Please change the name on the account to my new name: __________me] SAMPLE LETTER 2 [Insert Date] Client Services [Insert Company Name] [Insert Company Address] RE: ACCT. # [insert account number if applicable] To Whom It May Concern: I am writing to inform youeed additional information or documentation, please do not hesitate to contact me at (______) ________-______________. Thank you for your prompt attention to this matter. Yours Truly, [Insert your nato the following: ___________________________________ New Name ___________________________________ Street Address ___________________________________ City, State and Zip If you have any questions or n________________ Former Name ___________________________________ Former Street Address ___________________________________ Former City, State and Zip Please change the name and address on the account licable] To Whom It May Concern: I am writing to inform you that I have recently been divorced and have changed my name and address. The current name and address for my account are ___________________ps.com/moversguide/ Divorce ­ Name Change Kit (Instructions) 7 SAMPLE LETTER 1 [Insert Date] Client Services [Insert Company Name] [Insert Company Address] RE: ACCT. # [insert account number if appice to inform them of your name change, but you will need to inform them of any address changes. The forms for the address change can be found at your local post office or on the web at: http://www.usthe phone, or by using one of the letters enclosed with this package. [_] Post Office. You will soon begin receiving mail under your new name. You don't need to officially contact the U.S. Postal Servther Medical Personnel. You should contact any doctors, dentists, or other medical personnel with whom you have an ongoing relationship and inform them of your name change. This may be done either on can use one of the enclosed sample letters to make a simple name change, but may wish to contact the company for membership adjustments. Divorce ­ Name Change Kit (Instructions) 6 [_] Doctors and Oumber, or send them a letter informing them of you name change. Again, there may be additional steps to take if you maintained a joint membership at these clubs or organizations with your spouse. You nform them of the change. They may have you complete new 1044 or other forms. [_] Clubs and Organizations. If you are a member of a club or organization, you should either call their member services neasy. You work with these people, so they know you, or are at least inclined to trust you because you work with them. In any case, usually you will need only to contact your personnel department and iame. For your reference we have included a generic contract amendment with this kit. [_] Employee Documents. Making changes to employee documents (personnel records, W-2s, paychecks) is usually quite ntract will specify the steps necessary to amend any information on that agreement. Review your copy of these agreements, or contact your lawyer, to determine what steps you must take to change your ncom. [_] Contracts. If you personally are a party to any legal contracts (e.g., leases, supply contracts, services contracts), they will need to be amended to reflect your new name. Generally, each coy or make other amendments. Contact your lawyer or trust officer to discuss what steps you need to take to complete these changes. Forms for amending your will can also be found at www.findlegalforms.n this kit. [_] Wills, Trusts, etc. You should change your name on any will, trust, or other similar document. In addition, in connection with your divorce, you may also want to change your beneficiare additional steps of which your carrier will inform you. They may require that you send them written notification of this change. If that is the case, you can use one of the sample letters included irrier to inform them of your name change. Give your carrier a call (the contact information can be found on your last statement). If you wish to remove your spouse from this insurance, this may involv to notify your credit card companies of this change. [_] Insurance. If you intend to maintain the same car, home, or life insurance that you had during your marriage, you will need to contact your caname on that card, not only to avoid confusion, but because your driver's license will now have your new name and will not have or reflect your spouse's. You may use one of the attached sample letters credit card, that account may be dissolved and you may need to apply for a new card. Alternatively, you may have kept ownership of that account. If this is the case, it is a good idea to change your forward process, and representatives associated with those institutions will be able to answer any questions that you may have. [_] Credit Cards. If, during your marriage, you and your spouse shared ai.e., the accounts) has been divided in your divorce settlement, you may need to establish new accounts for your property. Divorce ­ Name Change Kit (Instructions) 5 This should be a fairly straightenerally accept your divorce decree and driver's license). In some instances, you may need to appear in person with your former spouse to sign off on the transfer. In some instances, if the property (ften, these types of institutions will require that you come in person and present them with acceptable proof of identity (this proof required will change depending on the institution, but they will gge. This will include any saving, checking, or investment accounts you have been awarded. Contact your bank or other financial services provider and ask them what the procedure for a name change is. Os. To the extent that the bank and investment accounts maintained during your marriage are deemed your property in your divorce settlement, you will need to inform those institutions of your name chanto send one, we have included two Sample Letters for this purpose. The first includes a change of address as well as a change of name. The second is a name change only. [_] Bank and Investment Accounttc.) will need to be changed to your new name. The process is very casual and is often best completed by making a phone call to the appropriate office. If they request a letter or if you would prefer bsite at: http://www.fec.gov/pages/electpg.htm [_] Utilities. If you are remaining at your old house or apartment, all of your utility statements (including water, gas, electricity, internet, cable, e also visit your local city hall, county courthouse or public library. All of these institutions should have the forms you need. For more information you can check the Federal Election Commission's weur driver's license. Many states include voter registration information and amendment opportunities on the same form with license amendments. Just ask the clerk at the DMV what you need to do. You can/irspdf/f8822.pdf or http://www.findlegalforms.com/public/f8822.pdf in Adobe Acrobat PDF format. [_] Voter Registration. Typically you can change your voter registration at the same time you change yoed to complete Form 8822 (access information can be found below). Mailing instructions and other information are included with the form. Form 8822 can be accessed from this link http://www.irs.gov/pub Information. Once you have contacted and made your name change official with the SSA, they will contact the IRS within 10 days to report the change. If you have also changed your address, you will ney for you passport by submitting Form DS-11. This will require additional documentation. For information on Form DS-11, visit http://travel.state.gov/passport/forms/ds11/ds11_842.html. [_] Federal Taxervisor 371971 500 Ross St, Room 154-0670 Pittsburgh, PA 15262-0001 Divorce ­ Name Change Kit (Instructions) 4 Option 3 If you don't qualify for either option 1 or option 2, you will need to reappl should be sent to: If using the U.S. Postal Service National Passport Processing P.O. Box 371971 Pittsburgh, PA 15250-7971 If using other delivery service Passport Services Lockbox ATTN: Password Supce decree, your old passport, two recent, color photos of you alone (2"x2"), and a check for the fee amount. The fee for this service is $67. The form, divorce decree, new photos, old passport and feeat http://travel.state.gov/passport/forms/ds82/ds82_843.html or at http://www.findlegalforms.com/public/ds0082.pdf. Along with your completed form, you will need to send a certified copy of your divorou can submit your old passport; ii) you were at least 16 years old when the passport was issued and iii) the passport was issued within the last 15 years. You can download this form off the internet essing ATTN: Department 13290 1617 Brett Road New Castle, DE 19720 Option 2 If your passport was issued more than one year ago, you will need to use either Form DS-82 or DS-11. Use form DS-82 if: i) yotos and old passport should be sent to: If using the U.S. Postal Service National Passport Processing P.O. Box 13290 Philadelphia, PA 19101-3290 If using other delivery service National Passport Proc fee for Divorce ­ Name Change Kit (Instructions) 3 this service. Once completed, your amended passport and divorce decree will be returned to you by priority mail. The form, divorce decree, new phrms.com/public/DS5504.pdf Along with the completed form, you will need to send a certified copy of your divorce decree, your old passport and two recent, color photos of you alone (2"x2"). There is nose Form DS-5504 (the U.S. Passport Re-application Form). You can download this form off the internet at http://www.travel.state.gov/passport/forms/ds5504/ds5504_2663.html and/or http://www.findlegalfoe same time. [_] Passport. Form DS-5504 and DS-82. If you have a U.S. passport, your name should be amended. Option 1 If your passport is currently valid and was issued within the last year, you can uu through the process. Note that if your registration sticker expires soon, you may make appropriate corrections on the renewal application; however, the title and registration must be corrected at thcle in order to complete a name change on your title. The procedures for this change will vary from institution to institution, but a representative of your financing company should be able to walk yon your search that you are looking for a Vehicle Registration replacement or a Duplicate Title). If your vehicle is being financed, you will need to contact the institution that is financing your vehid registration, and proof of insurance to a Service Center near you. To locate these offices, visit http://www.dot4.state.pa.us/locator/locator.jsp#top?20050401133920776=200504 01133920776 (indicate ia corrected registration, but to obtain a corrected title costs $22.50. Follow the instructions on the form carefully. Bring your completed forms, together with your driver's license, current title anpdotforms/mv_forms/mv-41a.pdf. Complete Side A of the form if you want an updated vehicle registration, and complete Side B of the form if you want an updated vehicle title. There is no fee to obtain ration. If you own the title to your car and you wish your title to reflect your new name, you will need to complete Form MV-41A, which may be found at the following link: http://www.dot4.state.pa.us/t http://www.dot4.state.pa.us/locator/locator.jsp#top?20050401133920776=200504 01133920776 (indicate in your search that you are looking for a Driver License replacement). [_] Vehicle Title and Registr's License, which may be found at the following link: http://www.dot4.state.pa.us/pdotforms/dl_forms/dl-80.pdf. There is no fee for this service. To locate the Driver License Center nearest you, visified divorce decree or other dissolution of Divorce ­ Name Change Kit (Instructions) 2 marriage documents reflecting your name change. You will also need to complete Form DL-80, Non-Commercial Drive. [_] Driver's License. To change your name on your driver's license you must go in person to your local Driver License Center where you will be asked to show your old license and a copy of your certibook or you can call 1-800-772-1213. Form SS-5 can be downloaded from the following link. http://www.ssa.gov/online/ss-5.pdf or http://www.findlegalforms.com/public/ss5.pdf in Adobe Acrobat PDF formatrm should be mailed (along with the original or certified copy of your divorce decree) to your local Social Security Office. The office will be listed under U.S. Government Agencies in your telephone r original divorce decree. If you feel uncomfortable mailing an original or a certified copy of your divorce decree, you can visit your nearest Social Security Office in person. Once completed, the foound below). You will need to provide proof of your name change--your divorce decree will qualify. The SSA requires the original document, so if you mail your SS-5 form, you will also need to mail youeck with the SSA to ensure that the information is the same before issuing you a new driver's license. To change your name on your social security card, complete Form SS-5 (access information can be fame with the Social Security Administration (the "SSA") before attempting to change your name on your driver's license. The reason for this is that the Department of Motor Vehicles (the "DMV") will ch: Changing Documents and Identification. To keep from getting confused or overlooking one of the forms, check each off as you complete it. [_] Social Security Card. Form SS-5. You should change your ne certified copy will cost and how soon it can be delivered to you. It may be helpful to provide your local clerk with the docket number associated with your divorce to facilitate this process. Step 3ed another copy of your divorce decree or other dissolution of marriage documents, you can visit the county or city clerk's office at which your divorce was granted. The clerk can tell you how much thp 1: Read the Instructions Carefully. You need to read these instructions as well as the instructions contained in any of the enclosed forms. Step 1: Certified Copies of Your Divorce Decree. If you ne_______________________ 3) _______________________ 4)________________________ Post Office Other:____________________ Other:____________________ Instructions Divorce ­ Name Change Kit Pennsylvania Ste___ Insurance Companies 1) _______________________ 2) _______________________ 3) _______________________ 4)________________________ Doctors and Other Medical Personnel 1) _______________________ 2) ________________ 3) _______________________ 4)________________________ Clubs and Organizations 1) _______________________ 2) _______________________ 3) _______________________ 4)_____________________)________________________ Contracts 1) _______________________ 2) _______________________ 3) _______________________ 4)________________________ Employee Documents 1) _______________________ 2) _______________________ 2) _______________________ 3) _______________________ 4)________________________ Wills, Trusts, etc. 1) _______________________ 2) _______________________ 3) _______________________ 4____________ 4)________________________ Bank and Investment Accounts 1) _______________________ 2) _______________________ 3) _______________________ 4)________________________ Credit Cards 1) _______ Change Kit Checklist Social Security Card Driver's License Vehicle Registration/Title Passport I.R.S. Voter Registration Utilities 1) _______________________ 2) _______________________ 3) ___________egligence or otherwise) arising in any way out of the use of these materials. An attorney should be consulted for all serious legal matters. Divorce ­ Name Change Kit (Information) 2 Divorce ­ Nameement of substitute goods or service, loss of use, data, or profits or business interruption), however caused and on any theory of liability, whether in contract, strict liability or tort (including nndLegalForms, Inc., its agents, partners or affiliates be responsible or liable for any direct, indirect, incidental, special, exemplary or consequential damages (including, but not limited to, procurt give any express or implied warranties of merchantability, suitability or completeness of any of the materials for your particular needs. The materials are used at your own risk. In no event will FiInc. does not provide legal advice. The purchase and use of these materials is subject to the "Disclaimers and Terms of Use" found at findlegalforms.com. These materials are provided "AS-IS." We do nome to time, so you should check with your local government agency to ensure that they are up to date. Disclaimer No Attorney-Client relationship is created by use of these materials. FindLegalForms, obe Acrobat Viewer to view and use them. PDF forms usually have to be either filled out by hand or on a typewriter. The forms linked in this packet may be modified by the State of Pennsylvania from tially and are not using a typewriter, use black ink and print as legibly and neatly as possible. Some of the forms to which we provide access may be in Adobe Acrobat PDF format. You will need a free Ad Form 8822 (I.R.S.) You can fill out the forms on the computer by entering the requested information in the appropriate fields or you can fill them out manually. If you are filling out the forms manuLetter 2; Contract Amendment; Links to Form DL-80 (driver's license); Links to MV-41A (vehicle title and registration); Links to Form SS-5 (social security); Links to U.S. Passport Forms; and Links tot contains the following forms: (i) (ii) (iii) (iv) Information for the Name Change Kit; Checklist; Instructions for the Name Change Kit; Sample Letter 1; (v) (vi) (vii) (viii) (ix) (x) (xi) Sample iii) recently or soon to be divorced. You may not use this packet if you are: (i) (ii) under the age of 18; or changing your name for fraudulent or other improper purposes. Materials This form packee; and a helpful checklist to ensure that you don't miss any thing. Good luck. Requirements To use this packet you must be: (i) Over the age of 18; (ii) a resident of the state of Pennsylvania; and (lect this. That's where we come in. This kit contains: forms that you will need to change your name on government documents; letters notifying companies, organizations, and agencies of your name changifies as a legal name change. You don't have to go to court again or get any other official decrees. But although you have legally changed your name, your records and identification cards will not refr former name and beginning your life anew. We hope to make this process as quick and as painless as possible. As a point of reference, a divorce decree granted by the state showing your new name qualInformation Divorce ­ Name Change Kit Pennsylvania Overview Divorce can be a difficult and confusing process for all parties. This name change kit is designed to simplify the process of reclaiming you Pennsylvania