Application for Change of Name
This form is an application to change your name. The form provided here is simply a sample of what the actual form looks like.
APPLICATION FOR CHANGE OF NAME
To: _______________________________ (Court)
Applicant states:
1. Applicant resides at _______________________________ (Address),
and has resided there for more than __________ (Months or Years) prior to filing this application.
2. Applicant was born in ______________________________ (Address)
on __________________ (Date of Birth).
Applicants birth name is _________________________.
3. The name of applicant's father is ______________________________,
and the name of applicant's mother is _____________________________.
They reside at ______________________________________ (Address).
4. Applicant _________ (Is/Is Not) married.
If married, applicant was married to:
_____________________________ (Spouse's Name)
on ___________________ (Date)
at ___________________________________ (Location and Address).
Spouse's Date of Birth: __________________________________
Spouse's Place of Birth: _____________________________________
5. Applicant desires to change (his/her) name to ____________________
for the following reasons:
____________________________
____________________________.
6. ____________________________
(State here any information relating to publication of notice of intent to change name, which may be required by statute.)
7. ____________________________
(State here any information required by statute as to financial matters, any criminal records, and pending actions or other proceedings to which the applicant may be a party.)
_______________________________
Signature
_______________________________
Date