Massachusetts Minor Name Change

Massachusetts Minor Name Change Information Gathering Form

General Information (for Court Filings)

Name of the Court:

Petitioner's Full Name:

Document Name:

Case Number (Docket No.):

Minor's Current Information

Current First Name:

Current Middle Name:

Current Last Name:

Date of Birth:

Place of Birth:

Occupation (Minor):

Minor's Proposed Information

Proposed First Name:

Proposed Middle Name:

Proposed Last Name:

Reasons for Name Change

Parent/Guardian Information & Consents

Petitioner's Relationship to Minor:

Petitioner has physical custody of the Minor.

Minor is a resident of the county in which the Petition will be filed.

Name change is not to avoid debts or defraud creditors.

Other Parent / Step-father Consent (if applicable)

Other Parent's Full Name:

Other parent has executed the Consent to Change of Name form.

Step-father's Full Name:

Step-father has executed the Consent to Change of Name form (if minor is taking his last name).

Petitioner's Signature