Fill and Sign the Nj Complaint Form 497319551

      Name       Street Address       City, State, Zip       Telephone Number In the Matter of the Application of:       Your Name To Assume the Name of:       Name you wish 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 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 Plaintiff in this matter. 2. I am (check one) am am not a citizen of the United States of America. 3. My social security number is       . 4. I was born on       , in       . (month, day, year) (place of birth) 5. I am the (check one) son daughter of       and       . 6. I was raised by       and       . 7. I have since birth been identified by the following names: (first, middle, last)             8. I (check one) have have not been married. 9. I (check one) have have no unsatisfied judgments of record, or suits pending against me, except: (enter any recording judgments or pending suits)             Revised 03/21/2016, CN 10551 - Name Change (Adult), Form A Page 1 of 2 10. I (check one) have have never been convicted of a crime, and have no criminal charges pending against me, except: (please supply county, municipality, nature, date of crime and/or pending charges)             11. This application (check one) is is not being made with the intent to avoid creditors or criminal prosecution or for other fraudulent purpose. 12. I (check one) have have not made any previous applications to assume another name. 13. I desire to have the name of:       . (first, middle, last) 14. 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 made by me 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 Revised 03/21/2016, CN 10551 - Name Change (Adult), Form A Page 2 of 2