Fill and Sign the New York Change Name Form

Supreme Court of the State of New York County of       In the Matter of the Application of       Index Number                                     ORDER GRANTING LEAVE for Leave to Change Their Name(s) To TO CHANGE NAME                                     Upon the annexed Petition(s) of                                     verified on       , requesting that the Petitioner(s) (minor children) be permitted to assume the name(s) of                         (And due notice of this application having been given to       , Order Granting Leave to Change Name(s) - 1 - ORDER GRANTING LEAVE TO CHANGE NAME INDEX NO. ____________ PAGE       OF       who is (are) the       of Petitioner(s)       ) and the Court being satisfied that the Petition is true, and it is appearing from the Petition and the Court being satisfied that there is no reasonable objection to the change of name(s) proposed, (and it appearing that the interests of the said infant(s) will be substantially promoted by the change,) it is hereby ORDERED that, 1.       . The individual currently known as:       . who was born on       . at       . (with birth certificate number       , issued by the Department of Health of       ) (with       as proof of birth, since no birth certificate is available) is hereby authorized to assume the name of:       in place and stead of his/her present name upon complying with the provisions of Article 6 of the Civil Rights Law and of this Order. 2.       . The individual currently known as:       . who was born on       . at       . (with birth certificate number       , issued by the Department of Health Order Granting Leave to Change Name(s) - 2 - ORDER GRANTING LEAVE TO CHANGE NAME INDEX NO. ____________ PAGE       OF       of       ) (with       as proof of birth, since no birth certificate is available) is hereby authorized to assume the name of:       in place and stead of his/her present name upon complying with the provisions of Article 6 of the Civil Rights Law and of this Order.) 3.       . The individual currently known as:       . who was born on       . at       . (with birth certificate number       , issued by the Department of Health of       ) (with       as proof of birth, since no birth certificate is available) is hereby authorized to assume the name of:       in place and stead of his/her present name upon complying with the provisions of Article 6 of the Civil Rights Law and of this Order.) 4.       . The individual currently known as:       . who was born on       . at       . (with birth certificate number       , issued by the Department of Health of       ) (with       as proof Order Granting Leave to Change Name(s) - 3 - ORDER GRANTING LEAVE TO CHANGE NAME INDEX NO. ____________ PAGE       OF       of birth, since no birth certificate is available) is hereby authorized to assume the name of:       in place and stead of his/her present name upon complying with the provisions of Article 6 of the Civil Rights Law and of this Order.) 5.       . The individual currently known as:       . who was born on       . at       . (with birth certificate number       , issued by the Department of Health of       ) (with       as proof of birth, since no birth certificate is available) is hereby authorized to assume the name of:       in place and stead of his/her present name upon complying with the provisions of Article 6 of the Civil Rights Law and of this Order.) 6.       . The individual currently known as:       . who was born on       . at       . (with birth certificate number       , issued by the Department of Health of       ) (with       as proof of birth, since no birth certificate is available) is hereby authorized to assume the name Order Granting Leave to Change Name(s) - 4 - ORDER GRANTING LEAVE TO CHANGE NAME INDEX NO. ____________ PAGE       OF       of:       in place and stead of his/her present name upon complying with the provisions of Article 6 of the Civil Rights Law and of this Order.) 7. This Order, consisting of a total of       pages, shall be entered and the Petition upon which it was granted shall be filed, prior to the publication hereinafter directed, in the office of the Clerk of the Civil Court of the City of New York. 8. Within twenty days after the date of entry of this Order, a copy of this Order and supporting papers shall be served upon the: Judge’s Initials Immigration and Naturalization Service Selective Service       , a former spouse Bankruptcy Court New York State Division of Criminal Justice Services             10. Proof of service on the above indicated party(ies) shall be filed with the Clerk of this Court within 40 days of the date of entry of this order. Order Granting Leave to Change Name(s) - 5 - 11. At least once within twenty days after entry of this Order, a notice shall be published in       , a designated newspaper in       County, (and in       , a designated newspaper in ORDER GRANTING LEAVE TO CHANGE NAME INDEX NO. ____________ PAGE       OF             County,) in substantially the following form: Notice is herby given that an Order entered by the Civil Court,       County on the       day of       , bearing Index Number       , a copy of which in room       , grants me(us) the right to 1. Assume the name of My present name is             My present address is My place of birth is My date of birth is                   2. Assume the name of My present name is             My present address is My place of birth is My date of birth is                   3. Assume the name of My present name is             My present address is My place of birth is My date of birth is                   4. Assume the name of My present name is             My present address is My place of birth is My date of birth is                   5. Assume the name of My present name is             My present address is My place of birth is My date of birth is                   6. Assume the name of My present name is             My present address is My place of birth is My date of birth is Order Granting Leave to Change Name(s) - 6 -                   ORDER GRANTING LEAVE TO CHANGE NAME INDEX NO. ____________ PAGE       OF       12. Within forty days of the making of this Order, proof of such publication, by Affidavit, shall be filed with the Clerk of the Civil Court in the County of       . 13. Following the filing of the Petition and the entry of this Order as directed in Paragraph 2, above: the service of such Order and such papers as directed in Paragraph 3, above: the filing of proof of such service as directed in Paragraph 4, above: the publication of Notice as directed in Paragraph 5, above: and the filing of proof of such publication as directed in Paragraph 6, above, it is further ORDERED that Petitioner(s) and/or Minor(s): Shall be known as and by the name(s):                                                                         Which s/he/they is/are herby authorized to assume. _________________________________ _________________________________ Date Judge, Civil Court Order Granting Leave to Change Name(s) - 7 -