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Fill and Sign the Iowa Name Change Form

Fill and Sign the Iowa Name Change Form

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IN THE IOWA DISTRICT COURT FOR _________________ COUNTY ) IN RE THE NAME CHANGE OF: ) No. _________________________ ) ______________________________ ) ) ______________________________ ) Adult(s) ) ) PETITION FOR CHANGE OF NAME ______________________________ ) (Family) ) ______________________________ ) ) ______________________________ ) ) ______________________________ ) Minor(s) ) COMES NOW Petitioner(s) and for his/her/their petition under Iowa Code Chapter 674, states: A. As to Petitioner ______________________________ : 1. Petitioner’s present name is ______________________________ and he/she resides in ________________________ County, Iowa. 2. Petitioner is ____________ feet, ____________ inches tall; weighs ____________ lbs.; has ____________ color hair; and ____________ color eyes. 3. Petitioner is a __________________ (race) ____________ male/female who was born in ____________________________________ (city, county and state) on __________________ (date) . 4. Petitioner owns the following real estate in Iowa (set out legal description): ____________________________________________________________ . Petition for Change of Name - 1 - 5. Petitioner currently resides at ____________________________________ and has resided at the following addresses during the past five (5) years: Street Address City State Zip                                                                                                                                                                         6. Petitioner is (check) unmarried or married. 7. Petitioner desires a name change for the following reasons: ____________________________________________________________ . 8. Petitioner has not previously requested a name change pursuant to Iowa Code chapter 674. 9. A certified copy of petitioner’s birth certificate is attached to this petition. B. As to Petitioner ______________________________ : 1. Petitioner’s present name is ______________________________ and he/she resides in ________________________ County, Iowa. 2. Petitioner is ____________ feet, ____________ inches tall; weighs ____________ lbs.; has ____________ color hair; and ____________ color eyes. Petition for Change of Name - 2 - 3. Petitioner is a __________________ (race) ____________ male/female who was born in ____________________________________ (city, county and state) on __________________ (date) . 4. Petitioner owns the following real estate in Iowa (set out legal description): ____________________________________________________________ . 5. Petitioner currently resides at ____________________________________ and has resided at the following addresses during the past five (5) years: Street Address City State Zip                                                                                                                                                                         6. Petitioner is (check) unmarried or married. 7. Petitioner desires a name change for the following reasons: ____________________________________________________________ . 8. Petitioner has not previously requested a name change pursuant to Iowa Code chapter 674. 9. A certified copy of petitioner’s birth certificate is attached to this petition. C. Petitioner(s) is/are Father Mother Guardian of the following minor child(ren) : Petition for Change of Name - 3 - a. Minor, ______________________________ , is a ____________ (race) male/female ; ____________ feet ____________ inches tall; weights ____________ lbs; and has ____________ hair and ____________ eyes. He/She was born in the city of ____________ , county of ____________ , in the State of __________________ on the ______ day of __________________ , ____________ ; b. Minor, ______________________________ , is a ____________ (race) male/female ; ____________ feet ____________ inches tall; weights ____________ lbs; and has ____________ hair and ____________ eyes. He/She was born in the city of ____________ , county of ____________ , in the State of __________________ on the ______ day of __________________ , ____________ ; c. Minor, ______________________________ , is a ____________ (race) male/female ; ____________ feet ____________ inches tall; weights ____________ lbs; and has ____________ hair and ____________ eyes. He/She was born in the city of ____________ , county of ____________ , in the State of __________________ on the ______ day of __________________ , ____________ ; d. Minor, ______________________________ , is a ____________ (race) male/female ; ____________ feet ____________ inches tall; weights ____________ lbs; and has ____________ hair and ____________ eyes. He/She was born in the city of ____________ , county of ____________ , in the State of __________________ on the ______ day of __________________ , ____________ ; Certified copies of the minor’s birth certificates are attached hereto. Petition for Change of Name - 4 - WHEREFORE, petitioner(s) prays that the court enter an order changing the names of the petitioner’s and petitioner’s minor child(ren) : From To                                                                                     Signature of Petitioner Signature of Petitioner             Type or Print Name Type or Print Name STATE OF IOWA, COUNTY OF ______________________________ ) ss. I, ______________________________ , being first duly sworn upon oath, state that I am the petitioner in the foregoing petition; that I have read and know the contents of said petition, and that the allegations and statements contained therein are true and correct. ___________________________________ Petitioner’s Signature (observed by notary) Subscribed and sworn to before me this ______ day of _______________, 20____. __________________________________ Notary Public in and for the State of Iowa Petition for Change of Name - 5 - STATE OF IOWA, COUNTY OF ______________________________ ) ss. I, ______________________________ , being first duly sworn upon oath, state that I am the petitioner in the foregoing petition; that I have read and know the contents of said petition, and that the allegations and statements contained therein are true and correct. ___________________________________ Petitioner’s Signature (observed by notary) Subscribed and sworn to before me this ______ day of _______________, 20____. __________________________________ Notary Public in and for the State of Iowa Petition for Change of Name - 6 -

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