Fill and Sign the Petition to Change the Name of an Adult Form

NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA. Page 1 of 3 FM-N CA-100 Petition to Change the Name of an Adult (Rev. 11-2 016) Petition to Change the Name of an Adult Print your answers. 1. Discovery Level The discovery level in this case, if needed, is Level 1. 2. Petitioner a. My current legal name is: . F irst Middle Last b.I ask the Court to change my legal name to: . First Middle Last c.The reason I want to change my name is: 3. Personal Information My personal information is as follows: a.Home address : street address city county state zi p code b. Social Security Number: Or I do not have a Social Security Number. c.Date of birth : month day year d.All drivers’ license numbers issued to me during the last 10 years: Driver’s License Number State that Issued License Or I have not had a driver’s license during the last 10 years. Cause Number: (The Clerk’s office will fill in the Cause Number and Court Number when you file this form.) Name Change of: In the ______________ Court Number District Court County Court at Law County, Texas Print current full legal name of person asking for name change. Page 2 of 3 FM-N CA-100 Petition to Change the Name of an Adult (Rev. 11-2 016) e.Place of birth: city county state country f. Sex listed on my birth certificate: Male Female g. Race : 4. Criminal History a. Have you ever been charged with a Class A or B misdemeanor or a felony? Yes No If yes -- Write your FBI (Federal Bureau of Investigations) or SID (State Identification) number: FBI # SID # List all Class A or B misdemeanors and felonies with which you have been charged, whether or not you w ere convicted. If you need more space, attach an additional page. Offense Case Number County Court Numbe r Court District Court County Court District Court County Court District Court County Court District Court County Court District Court County Court b.Have you ever been convicted of a felony? Yes No If yes -- The court may order your name changed if you were pardoned or at least 2 years hav e pas sed since you received a certificate of discharge or completed court ordered community supervision or juvenile probation. You must attach proof to this Petition. List all of your felony convictions here. If you need more space, attach an additional page. Offense Case Number County Court Numbe r Court District Court County Court District Court County Court District Court County Court District Court County Court District Court County Court c.Are you required to register as a sex offender? Yes No If yes – You must attach proof that you notified the appropriate local law enforcement authority of your proposed name change. Page 3 of 3 FM-N CA-100 Petition to Change the Name of an Adult (Rev. 11-2 016) 5.Request for Judgment I believe this name change is in my interest or benefit and in the interest of the public. I ask the Court to make an Order to change my name, and any other Orders I may be entitled to. → Your Signature Date Your Printed Name Phone Mailing Address City State Zip Email Address: Fax # (if any) 6.Verification (You must sign in front of a notary below .) I swear under oath that the facts stated in this Petition to Change the Name of an Adult are true and correct. → Your Signature - Do NOT sign until you are in front of a notary ! [ Notary Stamps Here ] Notary’s Signature Y ou must attach these documents to your Petition: A legible and complete set of your fingerprints on a fingerprint card in a form acceptable to the Texas Department of Public Safety and Federal Bureau of Investigations. Write “Exhibit A” at the top. If you were convicted of a felony and you were pardoned, attach proof of pardon for each conviction. Write