Fill and Sign the Louisiana Change Name Form

      __________________ JUDICIAL DISTRICT PETITIONER PARISH / CITY OF       STATE OF LOUISIANA DIVISION: NUMBER:       DEFENDANT FILED: CLERK: PETITION TO CHANGE NAME OF MINOR The petition of ______________________________ , the parent or guardian of ________________________ , a minor, who is a resident of and domiciled in the Parish of __________________ , State of Louisiana, wishes to change minor child’s name to ________________________ for the following reasons: ______________________________ . The minor, ________________________ , was born on the ______ day of ____________ , ______ . Her Social Security number is       -       -       . She resides at: ______________________________ . This suit is brought under R.S. 13:4751 – 13:4755, and it is thus mandatory that the District Attorney of this Parish be served with a copy of this petition and cited to answer it. WHEREFORE, petitioner prays for Judgment changing minor child’s name from ________________________ to ________________________ . By: ______________________________       STATE OF LOUISIANA PARISH OF ________________________ BEFORE ME, the undersigned Notary Public, duly commissioned and legally qualified in and for the Parish and State aforesaid, personally came and appeared __________________ who, being first duly sworn, did depose and say that: 1. He is the Petitioner in the above and foregoing proceedings; 2. He has read the same; and 3. All of the allegations of fact contained therein are true and correct, to the best of his knowledge, information, and belief. ___________________________________       SWORN TO AND SUBSCRIBED before me this ____ day of _______________ ____. _________________________________ NOTARY PUBLIC Petition to Change Name of Minor Page 1 of 1