Maine Name Change

STATE OF MAINE
ADULT NAME CHANGE PETITION / AFFIDAVIT

I. PETITIONER INFORMATION

Current First Name:

Current Middle Name:

Current Last Name:

Desired First Name:

Desired Middle Name:

Desired Last Name:

Date of Birth:

Current Address:

Street Address:

City:

State:

Zip Code:

County of Residence:

II. REASON FOR NAME CHANGE

Please state the proper and reasonable cause for the requested change of name:

III. DECLARATIONS

I am at least 18 years of age.

I have been a resident of the county in which I will file for the required amount of time as reflected in the law summary.

I am not changing my name to avoid debts or defraud creditors.

IV. AFFIDAVIT / SIGNATURE

I declare under penalty of perjury that the foregoing is true and correct.

V. NOTARY PUBLIC

State of Maine, County of .

On this day of , , personally appeared before me, , known to be the person(s) whose name(s) is/are subscribed to the within instrument, and acknowledged that he/she/they executed the same for the purposes therein contained.

Notary Public Signature:

Printed Name:

My Commission Expires: