Fill and Sign the Kentucky Name Change 497308167 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 execute 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 Justice 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 original 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 on 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 PETITIONER: 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 your 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