STATE BAR OF GEORGIA MEMBERSHIP 104 MARIETTA STREET SUITE 100 ATLANTA GA 30303 REQUEST FOR NAME CHANGE -- FAX FORMS TO (404) 527-8747 Please be advised that the following attorney has changed their name. Bar Number____________________ Current name on Bar Membership Records____________________________________ Please change the current name on Bar Memb ershipRecords to reflect the new name below (copy of legal document that changed name must be provided). New Name___________________________________________ Address______________________________________________ City____________________ State__________ Zip_________ Office Telephone Number______________________ Home Telephone Number_______________________ Email_______________________________________ Check below if this also reflects a change of address. ____The above also reflects a change of address. Please make the above referenced change in my records. If you have any further questions regarding this matter please call me at ______________________. _____________________________________________ (Sign name here) (Date) Questions: Call (404) 527-8777 or email membership@gabar.org