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Fill and Sign the Civil Court of the City of New York Judiciary of New York Form

Fill and Sign the Civil Court of the City of New York Judiciary of New York Form

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Civil Court of the City of New YorkCounty of ______________________Index Number _________________ In the Matter of the Application of CONSENTfor Leave to Change His/Her Name To_____________________________________STATE OF NEW YORK, COUNTY OF ______________________ss.:_________________________________________________, being duly sworn, says:I am (over the age of eighteen) (fourteen years of age or over) and reside at____________________________________________________________________________I am (the Minor child) (the parent of the Minor child) (Spouse of the Petitioner) hereinI have read the within Petition dated _________________________, requesting a changeof name from _______________________ to ________________________________________I consent to such change.________________________________________Signature of Affiant in the presence of the NotarySworn to before me this_______ day of __________, 20____.______________________________Notary PublicCIV-GP-82C (Revised October, 2003

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