Fill and Sign the Affidavit Name Change 497321740 Form

Civil Court of the City of New York County of       Index Number In the Matter of the Application of       AFFIDAVIT for Leave to Change His/Her Name To       State of New York ) ) County of       )       , an adult, having been first duly sworn according to law, on oath deposes and states as follows: 1. That       is the Petitioner in the above-entitled matter in which Petitioner seeks to change name from       to       . 2. That the Petitioner is currently a resident of       County, New York. 3. That the Petitioner is: unmarried and has not been previously married; unmarried and was previously married to       , whose current address is       ; married to       , whose address is       and has not been previously married; or married to       , whose address is       and was previously married to       , whose address is       . AFFIDAVIT - 1 - 4. That the Petitioner does not have any children has ___ children. The names, ages and addresses of Petitioner’s children are as follows: NAME AGE DOB ADDRESS                                                                                                                                                                                          Dated this       day of       , 20       . Petitioner       Type or Print Name       being duly sworn, deposes and says: I am the petitioner in the above-captioned action. I have read the affidavit and know the contents to be true to my own knowledge, except to those matters alleged on information and belief and as to those matters I believe them to be true. AFFIDAVIT - 2 - ____________________________________ PETITIONER Sworn to before me on this the       day of       , 20       . ____________________________________ NOTARY AFFIDAVIT - 3 -