Wisconsin Report of Legal Name Change (F-05021)
Official state formLegal name changeForm F-05021Free downloadLast verified November 14, 2026
Report of a court-ordered name change that the clerk of court completes and seals. It is sent with payment to the Wisconsin State Vital Records Office so the birth record, and optionally the marriage record, can be changed.
Who can use this form
- A person whose name was changed by a court order, who wants the Wisconsin birth record changed.
- The clerk of court or tribal clerk completes and seals the certification part. The form is not completed by the person alone.
- A person who must register as a sex offender may not change their name (Wis. Stat. 301.47).
What to send with it
- The completed form with the clerk of court certification, signature and court seal.
- A check or money order payable to State of Wis. Vital Records.
- Fees listed on the form: $10 to change the birth record, $10 to change the marriage record, $20 for the first certified copy and $3 for each additional copy issued at the same time.
Where to send it
- Mail to
- State Vital Records Office ATTN: PSSU PO Box 309 Madison, WI 53701-0309
- State fee
- Change of birth record $10; change of marriage record $10; first certified copy of the amended record $20; each additional copy $3. All as printed on the form.
- Typical processing
- Not provided
- Form revision
- 08/2024
- Source
- Official government page