Information Applicant

AFFIDAVIT OF NAME CHANGE

State of Texas

County of cooke

Current Name of Applicant: Rachelle L. Patten- Wimmer

Approximate Date Current Name Was Assumed: June 11, 2015

Former Name of Applicant: Rachelle L. Wimmer

Applicant's Date of Birth : June 25, 1979

Number of Years You Have Known the Applicant:

By Current Name By Former Name

1 month 2 years

Your Relationship to the Applicant: close friend of family

The variance in the applicant's name shown on his/her birth records and the name currently used:

maiden name, Patten- was added to last name Wimmer

Current name is used as an "also known as" name.

Rachelle L. Patten- Wimmer's current address is 1225 west malone ave, san antonio, Texas 78225

I solemnly swear (or affirm) that the information given above by me is true and correct to the best

of my knowledge and belief, that the applicant named above has been known by both his or her

present and former names as stated and is one and the same person; that the applicant is known

by his or her present name to friends and relatives, and in the community in which he or she is

residing.

Wallace Counterman Date

1225 west malone ave

san antonio, Texas 78225

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STATE OF TEXAS, COUNTY OF COOKE, ss:

This Affidavit was acknowledged before me on this day of,

by Wallace Counterman, who, being first duly sworn on oath according to law, deposes

and says that he/she has read the foregoing Affidavit subscribed by him/her, and that the matters

stated herein are true to the best of his/her information, knowledge and belief.

Notary Public

Title (and Rank)

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