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And Now This Day of 20 a Petition to Change Name Form

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IN THE COURT OF COMMON PLEAS OF __________________ COUNTY, PENNSYLVANIA CIVIL ACTION - LAW IN RE: CHANGE OF NAME OF : : : : :NO. _______________ : : : O R D E R AND NOW, this ______ day of __________________ 20______, a Petition to Change Name having been filed, the Petitioner is directed to provide Court Administration a copy of the Petition and a set of the fingerprints of the person whose name is to be changed. After the Court has received the Pennsylvania State Police certification required by 54 P.S. §702(b)(4), a hearing on the Petition will be scheduled by Court Administration.BY THE COURT:________________________________J. cc: Petitioner Court Administration

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