Fill and Sign the Order Changing the Name of an Adult Name Change Adults Form

NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA. FM-N CA-200 Order Changing the Name of an Adult (Rev. 07-2 016) Page 1 of 2 Order Changing the Name of an Adult A hearing took place today . 1.Appearances The Petitioner appeared in person without an attorney. 2.Jurisdiction and Record The Court finds that it has jurisdiction ov er this case and the Petitioner. A c ourt reporter : (Check one.) di d did not record today’s hearing. 3.Findings The Court finds that Petitioner’s personal information is as follo ws: a. Current le gal name: ________________________________________________________________ fi rst middle last b.Home Address: _ _________________________________________________________________ __ st reet address city county state zip code c. Social Security Number: ___________________________ _ O r Petitioner does not have a Social Security Number. d. All driver’s license numbers issued to Petitioner during the last 10 years: Driver’s License Number State that Issued License Or Petitioner has not had a driver’s license during the last 10 years. e.Date of birth: ___ _____________________________ __ m onth day year f.Place of birth: _____________________________________________ ________________________ ci ty county state country g.Petitioner is : (C heck one.) Mal e Female h.Petitioner’s race is : . Cause Number: Print court information exactly as it appears on Petition Name Change of: In the ______________ Court Number District Court County Court at Law County, Texas Print current full legal name of person asking for name change. FM-N CA-200 Order Changing the Name of an Adult (Rev. 07-2 016) Page 2 of 2 i. Petitioner : (Check one.) does not have FBI number or SID number. Petitioner’s FBI (Federal Bureau of Investigations) number is: ______________ _____________ . Petitioner’s SID (State Identification) number is : . j.Petitioner : (Check one .) has not been charged with a class A or B misdemeanor or felony. has been charged with the following class A or B misdemeanors or felonies: Offense (crime) Case Number County Court Number Court District Court County Court District Court County Court District Court County Court District Court County Court District Court County Court k.Petitioner: (Check one.) has not been convicted of a felony. has been convicted of a felony and has been pardoned. has been convicted of a felony and at least two years have passed since Petitioner received a certificate of discharge or completed court ordered community supervision or probation. l.Petitioner: (Check one.) is not required to register as a sex offender. is required to register as a sex offender and has submitted a Sex Offender Update Form to local law enforcement and provided proof to the Court of the submission. m.Petitioner ’s P etition to Change the Name of an Adult included a legible and complete copy of Petitioner’s fingerprints . n. Petitioner’s change of name is in Petitioner’s interest or benefit and is in the interest of the public. 4.Orders The Court ORDERS that Petitioner’s name is changed from : current name: first middle last to this name : first middle last 5.Other Orders The Court has the right to make other orders, if needed, to clarify or enforce this order. Any orders requested that do not appear above are denied. SIGNED ON: __________________________ __________________________________________ Judge’s Signature