I, the undersigned, declare that I am 18 years of age or older and
further declare:
1. I, Christopher Michael Munson, was born Doreen Lynn Munson in Jefferson
County in the State of Wisconsin on January 31, 1968.
2. I HEREBY DECLARE my intent to change my legal name, and be henceforth
exclusively known as Christopher Michael Munson.
3. I, the undersigned, wish to execute my Will, Living Will and Power
of Attorney using the name Christopher Michael Munson. Additionally,
the undersigned wishes to change his name with the Social Security Administration
to Christopher Michael Munson.
4. I further declare that I have no intention of defrauding any person
or escaping any obligation I may presently have by this act.
5. NOTICE IS HEREBY GIVEN to all agencies of the State of Wisconsin,
all agencies of the Federal Government, all creditors and all private
persons, groups, businesses, corporations and associations of said legal
name change.
I declare under penalty of perjury under the laws of the State of Wisconsin
that the foregoing is true and correct.
Date
New Signature
Old Signature
