Statutory Declaration of Resumption of a Former Name

STATUTORY DECLARATION OF RESUMPTION OF A FORMER NAME

I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:

1. My records currently show the name ______. I am resuming my former name, ______.

2. The reason I am resuming this name is: ______, which relates to an event on or about ______.

3. From the date of this declaration, I intend to be known by, and to use, the name ______ for all purposes.

4. I make this declaration to confirm my name for the following purpose: ______.

I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath.

DECLARED before me at the ______________________ of ______________________, in the Province of Ontario, this ______ day of ______________, 20______.

_______________________________ _______________________________

A Commissioner for taking Affidavits Signature of Declarant