Fill and Sign the Name Change of Parent and Minor Children Lawhelporg Form

Form D – Rev. 02/201 8 Page 13 FACT SHEET (INFORMATION REGARDING THE FATHER OF MINOR CHILD) Each Petitioner shall answer the following questions fully and completely and submit this FACT SHEET with your Petition for Change of Name. 1. What is the name on you r Birth Certificate? What is the File No? Dated ________________________________________ _________________ ____________ 2. What is the name on your Certificate of Naturalization? What is the No? Dated ______________________________________________ ______________ ____________ 3. What name appears on your social security card? 4. What name do you use in your employment? 5. List all of your marriages, divorces, dates and places thereof: Married to Date of Marriage Place of Marriage Divorced From Date of Divorce Place of Divorce 6. List the names, date and place of birth of all your living children: Name Date of Birth Place of Birth 7. What is the reason for legalizing this name change? ________________________________________________________________________________ ________________________________________________________________________________ Form D – Rev. 02/201 8 Page 14 8. I was born/married in the State of Hawaii, and wish to have the name on my birth certif icate amended in the follow ing way: ______________________ _________________________ _______________ First Name Middle Name Last Name 9. I (Minor Child) was born in the State of Hawaii, and wish to have the name on my birth certi ficate amended in the following way: ______________________ _________________________ _______________ First Name Middle Name Last Name ______________________ _________________________ _______________ First Name Middle Name Last Name ______________________ _________________________ _______________ First Name Middle Name Last Name Form D – Rev. 02/201 8 Page 15 FACT SHEET (INFORMATION REGARDING THE MOTHER OF MINOR CHILD) Each Petitioner shall answer the following questions fully and completely and submi t this FACT SHEET with your Petition for Change of Name. 1. What is the name on your Birth Certificate? What is the File No? Dated ________________________________________ _________________ ____________ 2. What is the name on your Certificate of Natu ralization? What is the No? Dated ______________________________________________ ______________ ____________ 3. What name appears on your social security card? 4. What name do you use in your employment? 5. List all of your marriages, divorces, dates and places thereof: Married to Date of Marriage Place of Marriage Divorced From Date of Divorce Place of Divorce 6. List the names, date and place of birth of all your living children: Name Date of Birth Place of Birth 7. What is the reason for legalizing this name change? ________________________________________________________________________________ ________________________________________________________________________________ 8. I was born in the State of Hawaii, and wish to have the n ame on my birth certificate amended in the follow ing way: ______________________ _________________________ _______________ First Name Middle Name Last Name