Fill and Sign the In Re Change of Name for Form

AOC -295 Doc.Code:PNC Rev. 4 -01 07/5/2001 03:07 pm Page 1 0f 1 Ver. 1.01 Commonwealth of Kentucky Court of Justice KRS Chapter 401 PETITION FOR NAME CHANGE Case No. ________________ Court District Family County ___________________ IN RE: CHANGE OF NAME FOR COME(S) THE PETITIONER(S), (choose one) : and , living parents of the above captioned minor ( minor refers to child under age 18, see KRS 401.020); or , surviving parent of the above captioned minor, or , guardian of the above captioned minor, or above captioned adult, AND IN SUPPORT OF THIS PETITION STATE(S): 1. The original name is . 2. The desired name is . 3. Birthdate (MM/DD/YYYY) of minor/adult 4. Birth location (city, county, state) of minor/adult is: , , 5. Minor/adult currently resides in the county in which this petition is filed. His/her address is: 6. Purpose of desired name change is: . I understand identity theft is a Class D Felony in Kentucky. KRS 514.160. I am not requesting this name change to avoid a legal obligation or evade prosecution . 7. For petition of minor with two living parents : Per KRS 401.020, if a parent refuses or is unavailable to execu te this Petition, proper notice of its filing shall be made on absent parent pursuant to the Rules of Civil Procedure. Father: Address: Mother: Address: WHEREFORE , Petitioner(s) pray(s) for an Order for Change of Name. Dated : _________________, 2_____. Petitioner’s Signature ___________________________ Petitioner’s Signature ______________________________ Attorney Name: HEARING Schedule hearing for ________________, 2____ at ___________ a.m./ p.m. ___________________ Judge Subscribed and sworn to before me this ______ day of _____________, 2_______. My commission expires: _______________, 2_______. _______________________________________ Notary Distribution for Hearing Notice: Petitioner(s) Attorney AOC -296 Doc.Code:ONC Rev. 2 -01 Commonwealth of Kentucky Court of Jus tice KRS Chapter 401 NAME CHANGE ORDER Case No. ________________ Court ____District__________ Division ___________________ County ___________________ IN RE: CHANGE OF NAME FOR PETITIONER(S), (choose one) and , living parents of the above captioned minor ; or , surviving parent of the above captioned minor, or , guardian of the above captioned minor, or above captioned adult, having filed a petition for name change, and the Court having held a hearing on the matter the Court makes the following FINDINGS OF FACT: 1. The origi nal name is 2. The desired name change is . 3. The minor, being less than 18 years old, / or the adult, being at least 18 years old, is years of age, his/her birthdate being , and his/her birthplace being , , City County State 4. The minor/adult is currently a resident of the county in which this petition is filed, his/her address being , , Street County City Kentucky, . Zip Code 5. For a minor’s petition only: a. The name of the minor’s father, if known, is . b. The name of the minor’s mother, if known, is . Based o n the above findings of fact, IT IS HEREBY ORDERED that the name is changed. _________________________________________ Judge Dated __________________________________, ________. Attorney Name and Address (If any) NOTICE TO ADULT PE TITIONER: Pursuant to KRS 186.540, if you have applied for or are in receipt of a Kentucky driver’s license, you have ten (10) days after entry of this Order to notify the Kentucky Transportation Cabinet in writing of your name change and the number of y our current driver’s license. NOTICE TO CLERK: Pursuant to KRS 401.040, if a name change is Ordered, send a certified copy of this Order to the county clerk for recording and instruct the petitioner to pay the county clerk’s recording fee. KRS 64.012