Fill and Sign the To Be Filled in by the Court Form

Revised 03/26/2016, CN 10551 - Name Change (Adult), Form C Page 1 of 1 Name Street Address City, State, Zip Telephone NumberIn the Matter of the Application of: Your NameTo Assume the Name of: Name you wish to assumeSuperior Court Of New JerseyLaw Division CountyDocket No. (To be filled in by the court) CIVIL ACTIONFinal Judgment , having made application to this Court by duly (your name, first, middle, last) verified complaint for a judgment authorizing (check one) him her to assume the name of , and it appearing to the Court that all the provisions of (name you wish to assume) N.J.S.A. 2A:52-1-4 and the Current N.J. Court Rules relating thereto have been complied with: IT IS ON THIS _____ day of ___________, 20_____, ORDERED and ADJUDGED that (leave blank for the court to complete) , was born on , and whose social (your name, first, middle, last) (month, day, year) security number is , be and hereby is authorized assume the name of (your social security number) , from and after , and (name you wish to assume) (leave blank for the court to complete) DO NOT WRITE BELOW THIS LINE THE COURT WILL COMPLETE IT IS FURTHER ORDERED that within twenty days hereof plaintiff shall cause a copy of this Final Judgment to be published once in ; and within forty-five days after entry of Judgment, plaintiff should file a proof of publication of this Final Judgment with the deputy Clerk of the Superior Court (in which you filed your verified complaint) and a certified copy of this Final Judgment with the Department of Treasury pursuant to the provisions of the Statute and Rules in such case made and provided; and IT IS FURTHER ORDERED that the published version of the final judgment shall not contain the social security number of the person whose name was changed. __________________Dated J.S.C.