Fill and Sign the Pennsylvania Name Change 497324758 Form

IN THE COURT OF COMMON PLEAS OF __________________ COUNTY, PENNSYLVANIA CIVIL ACTION - LAW IN RE: CHANGE OF NAME OF : NO. __________________ :       : a minor : : PETITION FOR CHANGE OF NAME OF MINOR TO THE HONORABLE JUDGES OF SAID COURT: The Petitioner ,       , requests that this Court order a change of name for       ,a minor child and in support thereof represents as follows: 1. Petitioner,       , whose date of birth is       , presently resides at       , in the County of       . 2. Co-Petitioner, ,       , whose date of birth is       , presently resides at       , in the County of       . 3. Petitioner request the Court to change the name of             , a minor child whose date of birth is       , and whose social security number is       , and who is residing with the Petitioner at the above address. 4. Petitioner is the parent of the minor child . 5. Petitioner(s) desire this change of name for the following reason(s):             Petition for Change of Name of Minor(s) Page 1 of 3 6. Petitioner is a citizen of the United States of America and his social security number is       . Co-Petitioner is a citizen of the United States of America and his social security number is       . 7. There are no judgments or decrees pending against the minor child. 8. WHEREFORE, Petitioner respectfully requests that this Court enter an Order changing the name of minor child from       to       . Respectfully submitted, _____________________________________ Petitioner       Type or Print Name Telephone Number       _____________________________________ Petitioner       Type or Print Name Telephone Number       VERIFICATION Subscribed and sworn to before me on this the ______ day of ____________ , 20 ______ . CLERK OF THE COURT OF COMMON PLEAS ________________________ or By _______________________________ Notary Public Deputy Clerk Petition for Change of Name of Minor(s) Page 2 of 3 My Commission Expires: ____________ Petition for Change of Name of Minor(s) Page 3 of 3