Fill and Sign the Minor Child Whose Form

Enter the name of the county in which this case was filed. Enter the name of the minor child whose name is proposed to be changed in this Petition. Enter Petitioner’s and Co-Petitioner’s (if any) name(s). You are the Petitioner(s). STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE CONFIDENTIAL NAME CHANGE OF First Name Middle Name By: (Petitioner) First Name The clerk will enter the case number. Last Name Middle Name(s) Last Name By: (Co-Petitioner) First Name Middle Name(s) Last Name Amended Petition for Confidential Name Change for Minor Child under 14 (30708) Case No. The petitioner(s) state(s): 1. The Petition is brought by In 1, check a, b, c or d. a. both living parents, the sole surviving parent, or the sole adoptive parent of the minor child. b. one of the parents of the minor child who has two living parents and paternity has been established. c. the mother, and the minor child is a non-marital minor child who is not adopted or whose parents have not married, and paternity of the minor child has not been established. d. the legal guardian/custodian of the minor child because either both parents are dead or the parental rights of both parents has been terminated by judicial proceedings. 2. Petitioner’s address is [County, Street Address, City, State and Zip] In 2, enter petitioner’s and co-petitioner’s address and the county in which the minor child lives. Co-Petitioner’s (if any) address is [County, Street Address, City, State and Zip] The minor child lives in County, Wisconsin. The minor child address is In 3, enter the date and state of birth of the minor child. 3. The minor child was born on [Date] . in the state of . 4. The name that appears on the minor child’s birth certificate is In 4, enter the name on minor child’s birth certificate. [First name] [Middle Name] [Last Name] CV-456, 05/19 Petition for Confidential Name Change for Minor Child under 14 §§301.47, 786.36 and 786.37, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materials Page 1 of 2 In 5, enter the state that the minor child’s birth certificate was issued. In 6, check the appropriate box. In 7, enter the proposed new name of the minor child. Enter the reason(s) for the change. 5. The birth certificate was issued in the state of 6. The minor child is is not a sex offender required to register under §301.45, Wis. Stats., or a similar law of any other state. 7. I/we wish to change the minor child’s name to . [First Name] [Middle Name] [Last Name] For the following reason(s): In 8, enter the reasons why you want your name change to be confidential. 8. I/we request that this Petition remain confidential because publication could endanger the minor child for the following reasons: Check 10, if you want the name changed on the child’s WI birth certificate. 9. I/we have not petitioned for a name change on behalf of the minor child to avoid a debt or conceal a criminal record. 10. I/we wish to change the name on the child’s Wisconsin birth certificate. I declare under the penalty of false swearing that the information I have provided is true and accurate.  I declare under the penalty of false swearing that the information I have provided is true and accurate.  Petitioner Signature Co-Petitioner Signature Print or Type Name Print or Type Name Date Date CV-456, 05/19 Petition for Confidential Name Change for Minor Child under 14 §§301.47, 786.36 and 786.37, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materials. Page 2 of 2