Petition for Change of Name of Adult

Petitioner makes the following declaration:

1. Birth Date and Place:   Petitioner was born on _______________________, ______ in  ________________________ [city],  ________________________ [county], ________________________ [state]. A certified copy of petitioner's birth certificate is attached to this petition.

2. Birth Name:  Petitioner was named ____________________________________________ at birth, and as of the date of this petition, the Petitioner has always been known by that name, with the following exceptions, if any:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
[list all legal names previously held].

3. Residence:  Petitioner resides at _______________________ [insert residential address] and has lived at this address for ________ [insert length of time in months or years at this address].

4. Petitioner's Parents:  The father of the Petitioner is named ______________________________________________, and he resides at _____________________________________________________________________________ [insert residential address of father].  The mother of the Petitioner is named ______________________________________________, and she resides at _____________________________________________________________________________ [insert residential address of mother]. 

5. Reason for Name Change:  Petitioner seeks to change his or her name to ______________________________________________ and offers the following reason(s) for seeking to do so:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________.

6. Legal and Creditor Status:  Petitioner does not have any outstanding judgments, has never been convicted of a crime, and is not involved in any pending legal actions.

7. Additional Declarations:  In addition to the foregoing statements, the Petitioner further declares:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
[insert additional declarations, if any].

NOW, THEREFORE, the Petitioner requests that the court order the Petitioner's name changed as follows:

Verification

I, ______________________________________________[name of Petitioner], affirm under penalty of perjury that I am the Petitioner in the foregoing Petition to Change Name of Adult and that all statements in this Petition are accurate to the best of my knowledge.
 

Subscribed and sworn to before me on this ____ day of __________________, 20_____.
 
 
__________________________________
Notary