Member Number:___________________
THE STATE BAR OF NEVADA
Member Services Department
Membership Records Name Change Form
Questions: Phone: (702) 317-1457 e-mail: stephaniew@
Please CLEARLY PRINT your previous name:
Member Bar Number: Date of Admission:
Previous Last Name: _ Previous First Name
Previous Middle Name: Second Middle Name:
Signature under this name: [pic]
Please CLEARLY PRINT your new name:
New Last Name: New First Name
New Middle Name: Second Middle Name:
Signature under this name:
Please provide a phone number
or email for questions regarding this request:
If your mailing address has changed, please complete a Change of Address form found here:
Completed forms and documentation may be emailed to: stephaniew@
OR mailed to:
State Bar of Nevada
Member Services
3100 W. Charleston Blvd.
Suite 100
Las Vegas, NV 89102
-----------------------
FOR OFFICIAL USE ONLY
To change an official name your request must be accompanied by one (1) copy of an official legal document showing the requestors new name. Examples of acceptable identity documents include photocopies of marriage license, divorce decree, passport, or birth certificate. Copies of driver’s license or social security cards are not acceptable forms of identification.
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