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City of Winter Haven, FL
551 3rd St NW
Change of Name Form
This form is to be used only to change a name in the instance of Marriage, Divorce or legal name change. You must have your Account number and copy of your new state issued I.D.
Previous Full Name
New Full Name
New Driver's License Number
Upload a copy of your new Driver's License
Last four of Social Security Number
I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.