Fill and Sign the New York Court 497321741 Form

SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF ____________ IN THE MATTER OF THE APPLICATION OF       , Petitioner, FOR LEAVE TO CHANGE       NAME TO: (His/Her)       . (Proposed New Name) AFFIDAVIT Index # ____________ State of New York ) ) County of       )       , an adult, having been first duly sworn according to law, on oath deposes and states as follows: 1. That       is the Petitioner in the above-entitled matter in which Petitioner seeks to change name from       to       . 2. That the Petitioner is currently a resident of       County, New York. 3. That the Petitioner is: unmarried and has not been previously married; unmarried and was previously married to       , whose current address is       ; married to       , whose address is       and has not been previously married; or married to       , whose address is       and was previously married to       , whose address is       AFFIDAVIT - 1 - . 4. That the Petitioner does not have any children has ___ children. The names, ages and addresses of Petitioner’s children are as follows: NAME AGE DOB ADDRESS                                                                                                                                                                                     DATED this ______ day of __________________ , 20 ______ . Petitioner       Type or Print Name       being duly sworn, deposes and says: I am the petitioner in the above-captioned action. I have read the affidavit and know the contents to be true to my own knowledge, except to those matters alleged on information and belief and as to those matters I believe them to be true. ____________________________________ PETITIONER Sworn to before me on this the       day of       , 20       . ____________________________________ AFFIDAVIT - 2 - NOTARY AFFIDAVIT - 3 -