Fill and Sign the New York Name Change Form

SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF ________________________ IN THE MATTER OF THE APPLICATION OF: PETITION       A Minor FOR LEAVE TO CHANGE HIS/HER NAME TO: INDEX NUMBER             The petition of       respectfully shows to this court: 1. The Minor Petitioner’s name is       . 2. The Minor Petitioner resides at       ,       New York, County of       . 3. The Minor Petitioner was born on the       day of       ,       , at       ,       , and is now       years of age. Attached hereto and made a part hereof is a certified transcript of the Minor Petitioner's birth certificate or a certificate of the Commissioner of Health that the Minor Petitioner's birth certificate is not available. 4. The Minor Petitioner wishes to discard       present name and assume the name of       . 5. The Minor Petitioner is a citizen of the United States. 6. The Minor Petitioner has never been convicted of a crime. 7. The Minor Petitioner has never been adjudicated or bankrupt. 8. There are no judgments or liens of record against the Minor Petitioner or actions or proceedings pending to which the Minor Petitioner is a party. 9. The grounds of this application to change Minor Petitioner’s name are as follows:       Petition - 1 - 10. No previous application has been made for the relief sought herein. 11. This action is brought pursuant to Article 6, Section 62 of the New York Civil Rights Law by: Both Parents of the Minor Petitioner One Parent of the Minor Petitioner       and the non-joining parent       was served with Notice of the Time and Place when and where this Petition would be presented by the joining parent. Next Friend, General Guardian, Guardian of       Person. WHEREFORE, Minor Petitioner respectfully prays for an order permitting him/her to assume the name       . DATED: at       , NEW YORK       , 20       On behalf of the Minor Petitioner by, ____________________________________ PETITIONER ____________________________________ PETITIONER       being duly sworn, deposes and says: I am the petitioner in the above-captioned action. I have read the petition 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 ____________________________________ PETITIONER Sworn to before me on this the       day of       , 20       . ____________________________________ NOTARY Petition - 2 -