Ds 60 Form – Fill Out and Use This PDF

U.S. Department of State	OMB APPROVAL NO. 1405-0133
AFFIDAVIT REGARDING A CHANGE OF NAME	EXPIRES: 05/31/2011
	ESTIMATED BURDEN: 15 MINUTES*

WARNING False statements made knowingly and willfully in passport applications or in affidavits or other supporting documents submitted therewith are punishable by fine and/or imprisonment under the provisions of 18 U.S.C. 1001 and/or 18 U.S.C. 1542. Alteration or mutilation of a passport issued pursuant to this application is punishable by fine and/or imprisonment under the provisions of 18 U.S.C. 1543. The use of a passport in violation of the restrictions contained therein or of the passport regulations is punishable by fine and/or imprisonment under 18 U.S.C. 1544. All statements and documents are subject to verification.

PURPOSE An Affidavit Regarding a Change of Name must be submitted with an application for a U.S. passport when the name which is used by the applicant is (1) substantially different from that shown on the evidence of citizenship or (2) has been adopted without formal court proceedings and was not acquired by a marriage. The affiant (preferably a blood relative) must have personal knowledge of the applicant's use of both names. To support a change of name that has been adopted without formal court proceedings or by a marriage, the applicant must present three or more public documents showing exclusive use of the name for at least five years. Affidavits Regarding a Change of Name from at least two persons attesting that they have known the applicant by born names and that the applicant has used the new name for all purposes for at least five years may be provided in place of one of the public documents if the applicant cannot obtain a third public document. Final determination of the name(s) to be shown in the U.S. passport will be made by Passport Services based on all of the evidence submitted. Completed affidavits will be retained and requests for copies of this affidavit should be made at the time of execution. An Affidavit does not need to be submitted if an applicant can present a court order documenting the change of their name.

1. Current Name of Applicant

Last		Title (Jr.,Sr.,III)
First		Middle
2. Approximate Date Current Name Was Assumed (mm-dd-yyyy)		3. Number of Years You Have Known the Applicant

4. Former Name of Applicant (or Name Given on Birth Records)

Explain the variance in the applicant's name shown on his/her birth records and the name currently used. State whether the current name is used exclusively and for all purposes or if it is used as an "also known as" name. Continue on the back of this form if additional space is required.

I solemnly swear (or affirm) that the information given above by me is true and correct to the best of my knowledge and belief, that the applicant named above has been known by both his or her present and former names as stated and is one and the same person; that the applicant is known by his or her present name to friends and relatives, and in the community in which he or she is residing.

	Printed Name of Affiant		Signature of Affiant
										(SEAL)
	Address of Affiant (Number and Street, City, State, and Zip Code )
	Identifying Document Submitted (Type of Document, Date of Issuance/Expiration, Document Number)
					day of
	Subscribed and Sworn to(Affirmed) before me this
						at
	Name of Passport Agent, Acceptance Agent, or Notary Public						Location (Passport Agency or City and State)

DS-60	Page 1 of 2
06-2008

For Additional Comments

PRIVACY ACT STATEMENT

AUTHORITIES: The information solicited on this form is requested pursuant to provisions in Titles 8 and 22 of the

United States Code (U.S.C.), whether or not codified including specifically 22 U.S.C. 211a, 212, 213, and all

regulations issued pursuant to Executive Order 11295 (August .5, 1966), including Part 51, Title 22, Code of Federal

Regulations (CFR).

PURPOSE: The primary purpose for soliciting the information is to establish citizenship, identity, and entitlement to

the issuance of a U.S. passport. The information may also be used in connection with issuing other travel documents

or evidence of citizenship, and in furtherance of the Secretary of State's responsibility for the protection of U.S.

nationals abroad.

ROUTINE USES: The information solicited on this form may be made available as a routine use to other

government agencies (such as the FBI, DHS, etc.), to assist the U.S. Department of State in adjudicating passport

applications and requests for related services, and for law enforcement and administrative purposes. It may also be

disclosed pursuant to court order. The information may be made available to foreign government agencies to fulfill

passport control and immigration duties or to investigate or prosecute violations of law. The information may also be

made available to private U.S. citizen 'wardens' designated by U.S. embassies and consulates for use in emergency

evacuation situations.

Failure to provide the information requested on this form may result in the denial of a United States passport, related

document, or service to the individual seeking such passport, document, or service.

PAPERWORK REDUCTION ACT STATEMENT

*Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. You are not required to respond to the collection of information unless this form displays a currently valid OMB number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/ISS/DIR) Washington, DC 20520.

DS-60

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