Fill and Sign the Change Name Adult Form

PRINT in INK Enter the name of the county in which this case was filed. STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use Enter your current name. You are the Petitioner . In the matter of the name change of:       _________________ First Name MiddleName Last Name The clerk will enter the case number. Amended Petition For Name Change (Adult or Minor 14 or Older) (30708) Case No.       I am the Petitioner and state: 1. My address is [Street Address, City, State and Zip]       2. I live in       County, Wisconsin. 3. I was born on [Date]       in the state of       . 4. My birth certificate was issued in the state of       and the name that appears on my birth certificate is       . 5. My current job is       . 6. A. I do not work in a job for which a license has been required by any state, or my only professional license is to teach in the public schools in this state. B. I do work in a job (other than a licensed teacher in Wisconsin public schools) for which a license has been required by any state. However, I have notified the state board or commission for my profession and they do not object to my proposed name change. 7. I am am not a convicted sex offender required to register under §§301.45, 938.34(15m), and 938.345(3), Wisconsin Statutes or a similar law of any other state. 8. I wish to change my name to [ First]       [ Middle]       [L ast]       . For the following reason(s):       9. I wish to change the name on my Wisconsin birth certificate. STOP! Take this document to a Notary Public BEFORE you sign it. After you have been sworn by a Notary Public, sign and print your name and date the document in front of the Notary Public . Have the Notary Public sign, date, and seal the document. State of       County of       Subscribed and sworn to before me on       Notary Public/Court Official Name Printed or Typed My commission/term expires:       4 Signature       Print or Type Name       Date CV-450, 11/13 Petition for Name Change (Adult or Minor 14 or Older) §§301.45 and 786.36, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materialsIn 1, enter your complete address. In 2, enter the County where you live. In 3, enter the date and state of your birth. In 4, enter the state that the birth certificate was issued and name as it appears on the birth certificate. In 5, enter your job title. In 8, enter your proposed new name. Enter the reason(s) you want to change your name. Check 9 if you want your name changed on your WI birth In 6, check a or b. In 7, check the appropriate box.