Fill and Sign the Petition Birth Form

STATE OF SOUTH CAROLINA ) IN THE FAMILY COURT OF THE )       JUDICIAL CIRCUIT COUNTY OF       ) ) )       and ) COMPLAINT FOR NAME CHANGE ) AND AMENDMENT OF BIRTH       ) CERTIFICATE Plaintiff(s) ) Docket No.       The Plaintiff(s) is(are) the Mother, and/or Father, of the Minor,       . The Minor was born in       County, State of       on the       day of       ,       , and presently resides in the County of       , State of South Carolina. The Minor’s legal name is       . The Plaintiff(s) desire(s) to change the Minor’s name to       . The Plaintiff desires the name for the following reasons:             The Plaintiff has no intention to defraud anyone or to avoid creditors by virtue of the name change. The Plaintiff respectfully requests this Court, pursuant to Section 15-49-10 of the South Carolina Code, Ann. (1976), to allow the Minor to change his/her name to:       . Plaintiff Plaintiff’s Address:                   , South Carolina Telephone No.             , 20       STATE OF SOUTH CAROLINA ) Complaint for Name Change Page 1 of 2 ) VERIFICATION COUNTY OF __________________ )       , being duly sworn, says that he/she is the Plaintiff (or       ) herein, and that he/she has read the foregoing complaint (or       ) and knows the contents thereof; that the same is true of his/her own knowledge, except as to matters therein stated to be alleged on information and belief; and to those matters he/she believes them to be true. SWORN to and Subscribed before me ) ) Plaintiff This       day of       , 20       . ) )       ) Notary Public for South Carolina ) My Commission expires       ) Complaint for Name Change Page 2 of 2