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)
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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)
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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)
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FAQs
Here is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
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