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DUAL AGENCY AFFIDAVIT Name of Licensee/Registrant: Main Office Address: Date: Deputy Superintendent of Banks Rhoda L. Ricketts New York State Department of Financial Services Mortgage Banking One
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How to Fill Out Dual Name Affidavit:

01
Obtain a copy of the dual name affidavit form from the appropriate authority or download it from their website.
02
Read the instructions and requirements carefully to ensure you understand what information and documentation is needed.
03
Begin by providing your personal details such as full legal name, date of birth, and contact information.
04
Next, clearly indicate the reason for needing a dual name affidavit, such as a change in marital status or a desire to assume a new name.
05
Provide the details of both your current name and the new name you wish to use. Ensure accuracy and consistency throughout the form.
06
If applicable, document any legally supporting details, such as marriage certificates, divorce decrees, or court orders. Ensure you have the necessary supporting documents before proceeding.
07
Review the completed form thoroughly to check for any errors or missing information. Make necessary amendments or additions if required.
08
Sign and date the affidavit in the presence of a notary public. Ensure the notary public also signs and stamps the document accordingly.
09
Make copies of the completed and notarized dual name affidavit for your records.
10
Submit the original notarized dual name affidavit to the relevant authority or agency as instructed in the form or accompanying instructions.

Who Needs Dual Name Affidavit:

01
Individuals who have recently gone through a change in marital status, such as marriage, divorce, or separation, may require a dual name affidavit.
02
Individuals who have decided to assume a new name due to personal reasons, such as religious or cultural preferences, may need a dual name affidavit.
03
People who are transitioning their gender identity and would like to use a different name may also require a dual name affidavit to legally establish their new name.
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A dual name affidavit is a legal document used to declare an individual's use of two different names.
Any individual who goes by two different names and wishes to legally confirm their use of both names is required to file a dual name affidavit.
To fill out a dual name affidavit, one needs to provide their legal name, the alternative name they use, the reason for using the alternative name, and their signature in front of a notary public.
The purpose of a dual name affidavit is to legally acknowledge an individual's use of two different names.
The information that must be reported on a dual name affidavit includes the individual's legal name, alternative name, reason for using the alternative name, and signature in front of a notary public.
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