Fill and Sign the New Jersey Minor Form

      Name       Street Address       City, State, Zip       Telephone Number In the Matter of the Application of:       Your Name (first, middle, last) To Change the Name of:       Name of Minor Child (first, middle, last) To:       Name you wish your child to assume Superior Court Of New Jersey Law Division       County Docket No.       (To be filled in by the court) C IVIL A CTION Verified Complaint Including Certification of Plaintiff for Name Change of Minor Child The plaintiff,       , whose place of residence is (your name, first, middle, last)       , in the City of       , County of (street address) (City)       , in the State of New Jersey says: 1. I am the Parent of       , and make this application to change (child's name, first, middle, last) my child's name to       (name you want your child to assume) 2. My child (check one) is is not a citizen of the United States of America. 3. My child's social security number is       . 4. My child born on       , in       . (month, day, year) (place of birth) 5. My child's other parent is named       . 6. My child is being raised by       , and       . 7. Since birth, my child been identified by the following names: (first, middle, last)             8. My child (check one) has has not been married. Revised11/17/2014, CN 10551 - Name Change (Minor), Form A Page 1 of 2 9. There (check one) are are no unsatisfied judgments of record, or suits pending against my child, except: (enter any recording judgments or pending suits)             10. My child (check one) has has never been convicted of a crime or delinquent behavior, and has no criminal or delinquent charges pending, except: (please supply county, municipality, nature, date of crime and/or pending charges)             11. a. I (check one) have have not been involved in a case in the Family Part in the past three years. b. My child (check one) has has not been involved in a case in the Family Part in the past three years. c. My child's other parent or guardian (check one) has has not been involved in a case in the Family Part in the past three years. If the parent(s) or child have been involved in a Family Part case, please describe the case and, if you can, provide the name of the case, the docket number, and the county where the case was heard                   12. This application (check one) is is not being made with the intent to avoid creditors or criminal prosecution or for other fraudulent purpose. 13. My child (check one) has ha not made any previous applications to assume another name. 14. I desire my child to have the name of:       . (first, middle, last) 15. I request this name change in the following reasons:                   WHEREFORE , plaintiff demands judgment pursuant to N.J.S.A. 2A:52-1 to -4. Signature of Plaintiff Certification I certify that the foregoing statements are true. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment.       Dated Signature of Plaintiff Revised11/17/2014, CN 10551 - Name Change (Minor), Form A Page 2 of 2 Revised11/17/2014, CN 10551 - Name Change (Minor), Form A Page 3 of 2