Fill and Sign the Minnesota Criminal History Check Form

Criminal History Check Release Minnesota Statute requires that the Court shall determine whether any person who is seeking to have their name changed has a criminal history in this or any other state. The court may conduct a search of national records through the Federal Bureau of Investigation by submitting a set of fingerprints and the required fee to the Bureau of Criminal Apprehension. To comply with Minn. Stat. § 259.11, you must supply the following information and attach this document when you file your application. You must complete a separate form for each party covered on the application, including a form for each minor that is 10 years of age or older. If there is a criminal history, both the court administrator and the name change applicant must report the name change to the Bureau of Criminal Apprehension within ten days of the date of filing. (See instructions for additional information.) First Middle Last Full Name List Any Other Names By Which You Have Been Known : First Middle Last _________________________________________________________________________________ _________________________________________________________________________________ Date of Birth  Female  Male Race I hereby give permission to law enforcement agencies, the Bureau of Criminal Apprehension and/or the Federal Bureau of Investigation to release criminal history information to the court. Your Signature If incomplete, we will not be able to process your application. Record information will be placed in the name change file that is accessible to the public. Do Not Write Below This Line For Bureau of Criminal Apprehension Records ______ No records found ______ See attached record(s) Verifier’s Signature (to be submitted to court) NAM103 State ENG Rev 9/07 www.mncourts.gov/forms Page 1 of 2 NAM103 State ENG Rev 9/07 www.mncourts.gov/forms Page 2 of 2