Fill and Sign the Name Change Forms Michigan Courts

2. The name change is for:a. a married person who wishes to also include a name change for:his/her spouse. his/her minor child(ren), of whom the petitioner has legal custody. b. an adult. c. a minor, whose natural or adopted parents are: and . Both parents are deceased. The guardian is . (Attach letters of guardianship.) 3. The name change is for the following reason: 4. The name change is not sought for any fraudulent intent. 5. The following person(s) seeking a name change has/have a criminal record: 6. Each person for whom a name change is sought has been a resident of the county for at least one year. 7. I have legal custody of the minor.a. The noncustodial parent has had the ability to visit, contact, or communicate with the child and has regularly andsubstantially failed or neglected to do so for a period of two years or more before the filing of this petition and either: a support order has been entered, and the noncustodial parent has failed to substantially comply with the order for a period of two years or more before the filing of this petition; or a support order has not been entered and the noncustodial parent, having the ability to support or assist in supportingthe child, has failed or neglected to provide regular and substantial support for two years or more before the filing ofthis petition. b. The noncustodial parent has been convicted of child abuse (MCL 750.136b), criminal sexual conduct (MCL 750.520b, MCL 750.520c, 750.520d, or 750.520e) , or assault with intent to commit criminal sexual conduct (MCL 750.520g) and the child or a sibling of the child was the victim. (Attach judgment of sentence.) c. The last-known address of the noncustodial parent is: The noncustodial parent is not living at the above address, and I have taken the following steps to locate him/her: (SEE SECOND PAGE) PC 51 (9/10) PETITION TO CHANGE NAME In the matter of the name change of to Approved, SCAO FILE NO. MCL 333.2872, MCL 711.1, MCR 3.613 PETITION TO CHANGE NAME Present first name(s), middle name(s), and last name(s) (type or print) Requested new first name(s), middle name(s), and last name(s) (type or print) Do not write below this line - For court use only STATE OF MICHIGAN JUDICIAL CIRCUIT - FAMILY DIVISION COUNTY Mother Father Name [Complete item 7 only if the name change is for a minor. Please see other side for remainder of petition.]1. An action within the jurisdiction of the family division of circuit court involving the family or family members of the person(s) named above has/have been previously filed in Court, Case Number , was assigned to Judge , andremains is no longerpending. JIS CODE: NAM 8.I request the following name change(s): (Type or print first name, middle name, and last name.) FROM TODATE OF BIRTH month, day, year month, day, year month, day, year month, day, year 9. I request the court to order the State Registrar to create a new live birth certificate that does not disclose the name of at birth and to seal the original certificate. I declare that this petition has been examined by me and that its contents are true to the best of my information, knowledge, a nd belief. 10. I am the spouse of the petitioner or the noncustodial parent of the minor and consent to the granting of this petition to ch ange name. 11. I am a minor 14 years of age or older, and I consent to the granting of this petition to change my name. 12. I am a minor under 14 years of age, and I state my preference to the above name change. Minor child Minor child Minor child Minor child Petitioner Spouse Name If you want a new live birth certificate, check item 9. A special order is not needed if you only want to add the changed name(s) to the original certificate(s). Date Date Petitioner signature Name (type or print) Petitioner signature Name (type or print)Address City, state, zip Telephone no. City, state, zip Address Telephone no. Date Minor's signature Minor's signature Date Date Signature Date Date Minor's signatureMinor's signature Bar no. Attorney name (type or print) Attorney signature Address City, state, zip Telephone no. month, day, year month, day, year