Fill and Sign the Sdlrc Codified Law 15 26a Sd Legislature Form

Form UJS -025 Verified Petition for Adult Name Change Rev. 0 6/201 1 1 STATE OF SOUTH DAKOTA ) IN CIRCUIT COURT )ss: COUNTY OF ____________ _______ ___ ) ______________ JUDICIAL CIRCUIT ******************************************************************************* In the Matter of the Petition of ) ) _________________________ ________ ) CIV: _______________ (Current Name) ) ) VERIFIED For a Change of Name to ) PETITION FOR ADULT ) NAME CHANGE _________________________ __________ ) (Proposed Name) ) ) **************** *************************************************************** COMES NOW Petitioner and does hereby state, under oath as follows : 1. Petitioner’s current name is ___________________ ______________ _________________. 2. Petitioner’s full name, as it appears on Petitioner’s birth certificate , is _________________ _____________________ _________________________________________. 3. Petitioner is an adult ________ years of age ; date of b irth : ____ ___ ___________________. 4. Petitioner’s gender at birth was: male / female. 5. Petitioner was born in _______________________, ___________________ County, State of ____________________________________. 6. The full maiden name of Petitioner’s mother is ______________________________. 7. The month, day and year of Petitioner’s mother’s birt h was ______________________ and she was born in ____________________, _______________________ County, State of ________________________. 8. The full name of Petitioner’s father as it appears on Petitioner’s birth certificate i s ______________________ ________ ______________________________. Form UJS -025 Verified Petition for Adult Name Change Rev. 0 6/201 1 2 9. Petitioner’s father was born on the ________ day of _____________________ , _______ __ and he was born in ____________________, _______________________ County, State of _________________________. 10. Petitioner’s street address is ________________ _______________________________ ___, __________________ County, South Dakota. 11. Petitioner has been a resident of __ ________________ County, South Dakota for more than six months prior to filing this petition. 12. The reason for wanting the name change is: _____________________________________ _________________________ _________________ ___ ___________________________ _____________________________________________ __ _________________________ _____________________________________________ __ ______________ ___________ ___________________________________________ __ ___________________________ _______________________________________________________ __ _______________ 13. This petition is made in good faith, I do not intend to defraud anyone, and it is not done for the purpose of hiding my identity from any person, creditor or governmental agency of any kind or as to avoid discovery by such person, creditor or governmental agency. 14. I request that my name be legally changed from __________________________________ _______ _______________________________ to _________________________________ ______________________ _______ ____ _____________________________. Form UJS -025 Verified Petition for Adult Name Change Rev. 0 6/201 1 3 Dated this ______ day of _______________________, 20_ ____ __. ______ _______________________________ Petitio ner (Signature ) _____________________________________ Print your name _____________________________________ Street address _____________________________________ City, State, ZIP code ____________________ _________________ Telephone Number VERIFICATION STATE OF SOUTH DAKOTA ) : SS COUNTY OF ________________ ) Petitioner , being first duly sworn, deposes and states that he or she verifies the facts expressed within the Verified Petition for A dult Name Change are true. Dated this ______ day of ___________________, 20 _____. _____________________________________ Petitioner ’s Signature Subscribed and sworn to before me this ______ day of ______________, 20 ____. _________________________ ____________ Notary Public/Clerk of Court (SEAL) If Notary, my commission expires:_____________