Wedge Co-op
NAME CHANGE FORM
To ensure that your name change does not infringe on Minnesota Co-op Law prohibiting the transfer of membership
stocks from one person to another, please fill out (please print) and sign the following form:
I ____________________________________________/_________________________ hereby declare the following:
(old name)
(member #)
I wish to become known as _______________________________/________________________________________
(first name)
(last name)
from ____/____/____ onwards in all my membership transactions at the Wedge Co-op.
(date)
___________________________________ and___________________________________ are one and the same person.
(old name)
(new name)
All my membership stock and equity remain in my sole possession and will not be transferred to another person as a
result of the name change specified above.
Signature_______________________________________________(old name)
Signature_______________________________________________(new name)
Address_______________________________________________City_____________________State_____Zip________
Phone________/______________________________________Email_________________________________________
Please bring this form to the Customer Service Counter 612/871-3993 or fax 612-871-0734
Or mail to: Wedge Co-op, 2105 Lyndale Ave S, Minneapolis, MN 55405 Attn: Membership