Legal Name Change Document

North Carolina Adult Name Change Application

Court Information:

Name of the Court:

Action/Cause No. (assigned by clerk):

Applicant Information

Current Legal Name:

Proposed New Name:

Date of Birth:

Race:

Sex:

Social Security Number (Optional):

Current Home Address:

Country:

Phone Number (Optional):

Email Address (Optional):

Are you a U.S. Citizen or Legal Permanent Resident? Yes No

County of Residence (for filing):

Eligibility & Reasons for Name Change

Are you at least 18 years of age? Yes No

State the good and sufficient cause for the requested change of name:

Are you changing your name as part of a divorce, adoption, or paternity matter? Yes No

Are you changing your name to avoid debts or defraud creditors? Yes No

Affidavit Re Outstanding Tax or Child Support Obligation

Do you have any outstanding tax obligations? Yes No

Do you have any outstanding child support obligations? Yes No

If you answered "Yes" to any of the above, please explain:

Affidavits of Character (Information for two non-related residents)

Affiant 1:

Full Name:

Address:

Relationship to Petitioner (Must NOT be related):

Affiant 2:

Full Name:

Address:

Relationship to Petitioner (Must NOT be related):

FBI Criminal Report Request Details (Optional, for My FBI Report)

Reason for Request: -- Select a Reason -- Personal Review/Correction Work Visa/Student Visa Foreign Residency/Travel Adoption Court Related Attorney Request

Would you like results mailed directly to your attorney? Yes No

If yes, Attorney's Full Name:

Attorney's Address:

Declaration and Signature

I affirm that the information provided in this application is true and correct to the best of my knowledge.