Fill and Sign the Petition Change Name 497300612 Form

 County Court  District Court ___________________ County, Colorado Court Address: In the Matter of the Petition of: For a Change of Name to: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION FOR CHANGE OF NAME (ADULT) 1. My current full name is ______________________________ __________________ ___________________ First Name Middle Name Last Name 2. I wish to change my name to ________________________ ___________________ ___________________ First Name Middle Name Last Name 3. My date of birth is ______________________________________. 4.  I am 18 years of age or older. 5. I am a resident of ________________________________________County. 6.  I have not been convicted of a felony or adjudicated a juvenile delinquent for an offense that would constitute a felony if committed by an adult in this state or any other state or under federal law. My certified, fingerprint-based criminal history record check from the FBI is attached as Exhibit A and my certified, fingerprint-based criminal history record check from the CBI is attached as Exhibit B. Both are dated within 90 days of the filing of this Petition pursuant to §13-15-101(b), C.R.S. 7. I am requesting a name change for the following reason(s): _______________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 8. The proposed change of name would be proper and not detrimental to the interest of any other person. 9.  I ask the Court to order publication of my name change request as required by § 13-15-102, C.R.S. Or  Publication of my name change request is not required for the following reason(s): _________________________________________________________________________________________ _________________________________________________________________________________________  By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form.  By checking this box, I am acknowledging that I have made a change to the original content of this form. JDF 433 R3-18 PETITION FOR CHANGE OF NAME (ADULT) VERIFICATION AND ACKNOWLEDGEMENT I swear/affirm under oath that I have read the foregoing Petition and that the statements set forth therein are true and correct to the best of my knowledge. ____________________________________ _________________________________________________ (Printed name of Petitioner) Signature of Petitioner ________________________________________________ Address ________________________________________________ City, State, Zip Code ________________________________________________ Telephone #: (home) (work) (cell) Signed and sworn to before me by _________________________________________in the County of _______________________, State of __________________, this _______, day of ________________, 20 ____. My Commission Expires: ___________________ _____________________________________ Deputy Clerk/Notary Public JDF 433 R3-18 PETITION FOR CHANGE OF NAME (ADULT)