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Table of Contents Fancy Design Alexandria Library Form

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IN THE CIRCUIT COURT OF ______________ COUNTY, VIRGINIA In the matter of the change of name of No. ____________ ______________________________ to ___________________________ PETITION FOR NAME CHANGE COMES NOW the petitioner(s) seeking a change of name for their child/ward pursuant to Virginia Code §8.01-217 and respectfully states under oath as follows: The child/ward currently resides in the County of ______________, City of ______________ . The petitioner(s) desire(s) a change of name for the following reasons: ______________________________________________________________________________ This change of name is not sought for any fraudulent purpose and will not infringe on the rights of another. The name of the child/ward is _____________________________________. The current address of the child/ward, including street, city and state of residence is ________________________________________________________. The child/ward's father is ________________________ and the child/ward's mother ________________________, whose maiden name is ________________________. The child/ward's date of birth is ____________, and the place of birth of the child/ward __________________. The child/ward has no felony conviction record, and is not currently incarcerated or a probationer with any court. The child/ward has never previously had a change of name. ____________________________________________ Signature(s) of Petitioner(s) Print Full Name: Daytime Phone Number: ( ) ___________________ IN THE STATE OF VIRGINIA, COUNTY OF __________________ I, the undersigned Deputy Clerk/Notary Public in and for the State of Virginia, do hereby certify that before me appeared ____________________________, whose name(s) is/are signed to the foregoing Petition, and acknowledged the same under oath before me. Given under my hand and seal this _____ day of _______________ 20____. _________________________ Deputy Clerk/Notary Public My Commission expires: _____________________

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