Fill and Sign the Order Name Change 497321766 Form

Civil Court of the City of New York County of       Index Number       In the Matter of the Application of ORDER       GRANTING LEAVE       TO CHANGE NAME for leave to Change Their Name(s) To             Upon the annexed Petition(s) of                               verified on       , requesting that the Petitioner(s) (minor children) be permitted to assume the name(s) of                         (And due notice of this application having been given to       , who is (are) the       of Petitioner(s)       ) and the Court being satisfied that the Petition is true, and it is appearing from the Petition and the Court being satisfied that there is no reasonable objection to the change of name(s) proposed, (and it appearing that the interests of the said infant(s) will be substantially promoted by the change,) it is hereby ORDERED that, 1       . The individual currently known as:       . who was born on       . CIV-GP-83 (Sheet D) (Revised, November, 2000 ) ORDER GRANTING LEAVE TO CHANGE NAME INDEX NO. ____________ PAGE 2 OF 6 at       . (with birth certificate number       , issued by the Department of Health of       ) (with       as proof of birth, since no birth certificate is available) is hereby authorized to assume the name of:       in place and stead of his/her present name upon complying with the provisions of Article 6 of the Civil Rights Law and of this Order. 2       . The individual currently known as:       . who was born on       . at       . (with birth certificate number       , issued by the Department of Health of       ) (with       as proof of birth, since no birth certificate is available) is hereby authorized to assume the name of:       in place and stead of his/her present name upon complying with the provisions of Article 6 of the Civil Rights Law and of this Order. 3       . The individual currently known as:       . who was born on       . at       . (with birth certificate number       , issued by the Department of Health of       ) CIV-GP-83 (Sheet D) (Revised, November, 2000 ) ORDER GRANTING LEAVE TO CHANGE NAME INDEX NO. ____________ PAGE 3 OF 6 (with       as proof of birth, since no birth certificate is available) is hereby authorized to assume the name of:       in place and stead of his/her present name upon complying with the provisions of Article 6 of the Civil Rights Law and of this Order. 4       . The individual currently known as:       . who was born on       . at       . (with birth certificate number       , issued by the Department of Health of       ) (with       as proof of birth, since no birth certificate is available) is hereby authorized to assume the name of:       in place and stead of his/her present name upon complying with the provisions of Article 6 of the Civil Rights Law and of this Order. 5       . The individual currently known as:       . who was born on       . at       . (with birth certificate number       , issued by the Department of Health of       ) (with       as proof of birth, since no birth certificate is available) is hereby authorized to assume the name of: CIV-GP-83 (Sheet D) (Revised, November, 2000 ) ORDER GRANTING LEAVE TO CHANGE NAME INDEX NO. ____________ PAGE 4 OF 6       in place and stead of his/her present name upon complying with the provisions of Article 6 of the Civil Rights Law and of this Order. 6. This Order, consisting of a total of       pages, shall be entered and the Petition upon which it was granted shall be filed, prior to the publication hereinafter directed, in the office of the Clerk of the Civil Court of the City of New York. 7. Within twenty days after the date of entry of this Order, a copy of this Order and supporting papers shall be served upon the: Judge’s Initials Immigration and Naturalization Service Selective Service       , a former spouse Bankruptcy Court New York State Division of Criminal Justice Services             8. Proof of service on the above indicated party(ies) shall be filed with the Clerk of this Court within 40 days of the date of entry of this order. 9. At least once within twenty days after entry of this Order, a notice shall be published in       , a designated newspaper in       County, (and in       , a designated newspaper in       County,) in substantially the following form: ORDER GRANTING LEAVE TO CHANGE NAME INDEX NO. ____________ CIV-GP-83 (Sheet D) (Revised, November, 2000 ) PAGE 5 OF 6 Notice is herby given that an Order entered by the Civil Court,       County on the       day of       , bearing Index Number       , a copy of which in room       , grants me(us) the right to 1. Assume the name of My present name is             My present address is My place of birth is My date of birth is                   2. Assume the name of My present name is             My present address is My place of birth is My date of birth is                   3. Assume the name of My present name is             My present address is My place of birth is My date of birth is                   4. Assume the name of My present name is             My present address is My place of birth is My date of birth is                   5. Assume the name of My present name is             My present address is My place of birth is My date of birth is                   10. Within forty days of the making of this Order, proof of such publication, by Affidavit, shall be filed with the Clerk of the Civil Court in the County of       . 11. Following the filing of the Petition and the entry of this Order as directed in Paragraph 2, above: the service of such Order and such papers as directed in Paragraph 3, above: the filing of proof of such service as directed in Paragraph 4, above: the publication of Notice as directed in Paragraph 5, above: and the filing of proof of such publication as directed in Paragraph 6, above, it is further ORDERED that CIV-GP-83 (Sheet D) (Revised, November, 2000 ) ORDER GRANTING LEAVE TO CHANGE NAME INDEX NO. ____________ PAGE 6 OF 6 Petitioner(s) and/or Minor(s): Shall be known as and by the name(s):                                                             Which s/he/they is/are hereby authorized to assume. _________________________ _________________________________________ Date Judge, Civil Court CIV-GP-83 (Sheet D) (Revised, November, 2000 )