Fill and Sign the Petition Change Name Sample Form

IN THE MATTER OF: * IN THE       * CIRCUIT COURT Child’s Current Name       * FOR Street Address       *       City, State, Zip       * Telephone * FOR CHANGE OF NAME TO: *       Child’s New Name * Civil No.:       BY AND THROUGH HIS / HER MOTHER / FATHER / GUARDIAN: *       * ( Petitioner’s Name) * * * * * * * * * * * * * PETITION FOR CHANGE OF NAME (Minor) (DOM REL 62) TO THE HONORABLE, THE JUDGE OF SAID COURT: Petitioner,       , a minor, by and through (child’s current name) his/her Mother Father Guardian respectfully represents to this Court: Check One 1. That the minor child was born on       , in       , (child’s birthdate) (child’s birthplace - city, state, country) and presently resides at       . (child’s present address) 2. That the child’s birth name is       . (child’s birth name) The child’s name has been changed to the following since birth for the following reasons: ( List any reasons why the child’s name may have been changed since birth, for example, adoption). Name Changed To: Reason:                                                 I have attached a birth certificate or other document reflecting the child’s current name 3. Select on of the following: Page 1 of 2 DR 62 (Rev. 9/2005) The child has never registered as a sexual offender; OR The child is or has been previously registered as a sexual offender under the following name:       Full Name as Registered 4. Petitioner wishes to change the child’s name to:       . (Child’s new name) 5. This change of name is being requested because:                                     6. The name and address of each parent, guardian and custodian of the child is:                   7. The other parent, guardian or custodian: Consents to and joins this petition. Has not consented at this time. Cannot be found, and I have attached an Affidavit and Motion to Serve by Alternative Means. 8. Petitioner hereby certifies that the above change of name is not requested for any illegal or fraudulent purposes. WHEREFORE, the I respectfully request that the Court pass an Order changing the minor child’s name from       to       . (current name) (new name) I,       , solemnly affirm under the penalties of perjury, that the contents of the foregoing paper are true to the best of my knowledge, information and belief.       (Date) Your Signature -- MOTHER/FATHER/GUARDIAN       Your Name - Printed       Address       City, State, Zip       Telephone Page 2 of 2 DR 62 (Rev. 9/2005)