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CHANGE OF
NAME OF First Middle Last Street Address City,
State Zipcode FOR CHANGE OF
NAME TO New First Middle Last |
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IN THE DISTRICT COURT STATE OF FOR (Indicate) COUNTY Civil
No. _________ |
PETITION TO CHANGE NAME
TO THE HONORABLE, THE
JUDGE OF SAID COURT:
Current
First Middle Last Name, pro se, respectfully represents unto
this Honorable Court as follows:
1. That
the Petitioner, Current First Middle
Last Name, was born on Month Day,
Year, in City, State.
2. That the Petitioner presently resides
at Street Address, City, State, Zipcode, county of (indicate
county). Petitioner has resided in said county for at least six (6) months.
Petitioner is a citizen of the
3. That
Current First Middle Last Name wishes
to change her name to New First Middle
Last Name.
4. Petitioner desires this change because
of social and personal beliefs/reasons.
5. The above change of name is not
requested for the purpose of concealment of identity or for any fraudulent
purpose.
6. There are no claims, demands or
liabilities on a written instrument or otherwise to which I am a party.
Further, no person will be adversely affected or prejudiced in any way by the
proposed change of name.
7. That Petitioner has not been known by
another name.
8. The name of Petitioner’s birth father
is Father’s First Middle Last Name.
9. The name of Petitioner’s birth mother
is Mother’s First Middle Last Name.
10. Petitioner has never been convicted of
felony.
WHEREFORE, your Petitioner prays that this
Honorable Court pass an Order changing her name from Current First Middle Last Name to New First Middle Last Name.
____(sign)______________________
Current First Middle
Last Name
Street Address
City, State Zipcode
VERIFICATION
Current
First Middle Last Name, being duly sworn on this ____day of
_____________, 20 , deposes and says (s)he is the
Petitioner named in the foregoing Petition, and that the matters and facts set
forth in the foregoing Petition are true to the best of her knowledge,
information, and belief.
___(sign)_____________________
Current First Middle Last Name
Subscribed and sworn to before me this _______
day of ______________, 20_________
_______________________
Notary
Public
My Commission Expires: ______________
