Fill and Sign the Order for Name Change City of Chesapeake Virginia Form

IN THE CIRCUIT COURT OF THE CITY OF , VIRGINIA In the matter of the change of name of At Law to to to to ORDER This day came the petitioner, seeking to change their name. IT APPEARING to the Court that: The petitioner(s)’ and child(ren)/ward(s) date of birth and place of birth are as follows:Full name Date of Birth Place of birth The petitioner’s father is and the petitioner’s mother is , whose maiden name is . The petitioner’s father is and the petitioner’s mother is , whose maiden name is . The child(ren)/ward(s)’s father is and the child(ren)/ward(s)’s mother is , whose maiden name is . The petitioner(s) and child(ren)/ward(s) have no felony conviction record, and are not currently incarcerated or a probationer with any court. The petitioner has never previously had a change of name. ADJUDGED, ORDERED, and DECREED that the name of the petitioner(s) and child(ren)/ward(s) are hereby changed as follows: 2 From: To: From: To: From: To: From: To: From: To: From: To: , ADJUDGED, ORDERED, and DECREED that the Clerk of this Court, pursuant to the provisions of Virginia Code Sec. 8.01-217 shall spread this order upon the current deed book, index it in both the old and new names, and transmit a certified copy to both the State Registrar of Vital Statistics and the Criminal Records Exchange. Entered this day of , 20 . ___________________________________ JUDGE I ASK FOR THIS: _____________________________ Signature of Petitioner _____________________________ Signature of Petitioner