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South Bend Lead Protection Program <br />FORM B – Supporting documents for <br />Need help? Contact Daniela Bautista-Amick dbautista-amick@southbendin.gov or 574-245- <br />6085 <br />Page | 6 <br /> <br /> <br />4 Gather and submit the documents to Daniela Bautista-Amick, Department of Community <br />Investment. <br />• Submit photos of one-page documents only (Examples: Driver’s licenses, income benefit <br />statements, tax statements, insurance declarations, etc.) to dbautista- <br />amick@southbendin.gov <br /> <br />• Submit electronic copies to dbautista-amick@southbendin.gov <br /> <br />• Submit paper copies by scheduling an in-person appointment or mail (Daniela Bautista- <br />Amick, 227 W JEFFERSON BLVD, STE 1300S SOUTH BEND IN, 46601) <br />About me Supporting documents Directions <br /> <br />1 Check all <br />statements that <br />apply to you. <br />2 Check the documents you need to <br />submit. We accept photos (one-page <br />documents only), electronic, and paper <br />copies. <br />3 Read directions for gathering <br />the right documents. <br /> Name change documents <br />About me Supporting documents Directions <br /> <br /> My legal name is <br />different from the <br />name on the <br />documents I will <br />provide. <br /> Copy of legal and recorded name change <br />document such as: <br />• Marriage license <br />• Divorce decree <br />• Other legal or court document showing <br />name change <br />Provide one of these documents if your <br />name is different on any of the <br />documents you will provide. <br /> <br /> My legal name is <br />the same name on <br />the documents I will <br />provide. <br /> None None <br /> <br /> <br /> <br /> <br />You’re done submitting supporting documents!