Witness to signature by mark
_______________________________
Signature of witness
_______________________________
Address of witness
Example: Deborah L. Gains, changed by order of court from Deborah G. O'Brien.
The individual must provide evidence, such as a certified copy of a court order, which confirms the change, unless it is indicated that the change of name resulted from marriage.
Example: Catherine M. Cole, changed by marriage from Catherine T. Murray.
31 C.F.R. §357.28
Approved by the Office of Management and Budget under control number 1535-0068