Fill and Sign the Maine Name Change 497310992 Form

MAINE ___________________ , SS. PROBATE COURT COUNTY DOCKET AFFIDAVIT BY ADULT SEEKING TO HAVE OWN NAME CHANGED In Re:       I,       , am over the age of 18 and am a resident of       in the County of       . I have petitioned to have my name changed to       . Under penalty of perjury I hereby affirm that: 1. I am not, by changing my name, attempting to avoid any legal obligation. 2. Children: (Check one) I have no minor children. I have the following minor children whose ages are:       3. I am not involved in any bankruptcy proceedings or arrangements among creditors in which my debts to others are being affected, nor do I reasonably anticipate that such proceedings or arrangements are about to begin. 4. I know of no person who had or has reason to have any objection to the change or name I am seeking. 5. (If applicable) The last name of which I am seeking to acquire (is) (is not) the last name of a former spouse. Date       Signature ___________________________ State of Maine       , ss.       , 20    County Personally appeared the above named       who, under penalty of perjury, affirmed the truth of the forgoing statement and acknowledged his/her signature theron to be genuine and to have been executed as his/her free act and deed. ____________________________________ Notary Public I hereby certify that in the preparation of this document, no alteration has been made to the official form as most recently approved and promulgated by the Supreme Judicial Court. I also certify that I have met the standards under M.R. Prob. P84 (b). Signed_______________________________ Dated: