Fill and Sign the Kentucky Petition Change Form

AOC-295 Doc.Code:PNC Rev. 10-08 Page 1 0f 1 Commonwealth of Kentucky Court of Justice www.courts.ky .gov KRS Chapter 401 PETITION FOR NAME CHANGE Case No.       Court       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 change 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: ________________________________ Subscribed and sworn to before me on _______________ , 2______. My commission expires: , 2 NotaryHEARING Schedule hearing for ________________ , 2 ____ at ___________ a.m. p.m. Judge Note: File this Petition in the Circuit Clerk’s Office in the county in where you reside. Distribution for Hearing Notice: Petitioner(s) OR Attorney for Petitioner(s), if any