PROCESSING NAME OR ADDRESS CHANGE TRUST:_______________________________________________________________________ MEMBER:________________________________________________________ CHANGE IN NAME Current Name:_______________________________________________________________ d/b/a________________________________________________________ New Name:_________________________________________________________________ d/b/a________________________________________________________ Effective date:_______________________________________________________________ CHANGE IN ADDRESS Current member address:______________________________________________________ _______________________________________________________ New Address:_______________________________________________________________ ________________________________________________________________ Effective date:_______________________________________________________________ ADD ADDITIONAL LOCATION Address:____________________________________________________________________ _______________________________________________________________ Effective date:_______________________________________________________________ ADD DBA Name:______________________________________________________________________ Effective date:_______________________________________________________________ DELETE ADDITIONAL LOCATION Address:______________________________________________________________ _______________________________________________________________ Effective date:______________________________________________________________ DELETE DBA Name:______________________________________________________________________ Effective date:_______________________________________________________________ Date letter sent:_______________________ Adjust File:__________________________ File:namechangecklist.doc 2000 (C) American LegalNet, Inc.