STATE OF SOUTH CAROLINA ) IN THE FAMILY COURT OF THE

) ELEVENTH JUDICIAL CIRCUIT

COUNTY OF LEXINGTON )
)
) AFFIDAVIT
(Name Change)
)
Plaintiff )
)
vs )
) Docket No. ___________
)
Defendant )

I, __________________, state that I am the Plaintiff in the above

captioned action and that I have never been convicted of a crime under a name different
than the name I am filing this Petition.

Columbia, South Carolina

___________,20_
Plaintiff's Signature

Subscribed and sworn to before me

This ____ day of

__________,20_

Notary Public for South Carolina

My Commission Expires: ____

I have been convicted of a crime under a name different than the name I am filing this
Petition. The name I was convicted under was _________________

Columbia, South Carolina

__________,20__
Plaintiff's Signature

Subscribed and sworn to before me

This ____ day of

__________,20_

Notary Public for South Carolina

My Commission Expires: ____

FC-nca