Fill and Sign the Va Name Change Form

IN THE CIRCUIT COURT OF THE CITY OF       , VIRGINIA In the matter of the change of name of At Law             to             to             to             to             to       PETITION FOR CHANGE OF NAME COMES NOW the petitioner(s) seeking a change of name pursuant to Virginia Code § 8.01-217 and respectfully states under oath as follows: A. 1. The petitioner currently resides in the County/City of       . 2. The current legal name of the petitioner is       . 3. The current address of the petitioner, including street, city and state of residence is       . 4. The petitioner’s father is       and the petitioner’s mother is       , whose maiden name is       . 5. The petitioner’s date of birth is       , and the place of birth is       . 6. The petitioner has no felony conviction record, or is not currently incarcerated or a probationer with any court. 7. The petitioner has never previously had a change of name. B. 8. The petitioner currently resides in the County/City of       . 9. The current legal name of the petitioner is       . 10. The current address of the petitioner, including street, city and state of residence is       . 11. The petitioner’s father is       and the petitioner’s mother is       , whose maiden name is       . 12. The petitioner’s date of birth is       , and the place of birth is       . 13. The petitioner has no felony conviction record, or is not currently incarcerated or a probationer with any court. 14. The petitioner has never previously had a change of name. C. 15. The child(ren)/ward(s) currently reside in the County of       , City of       . 16. The names of the child(ren)/ward(s) are as follows:       . 17. The current address of the child(ren)/ward(s), including street, city and state of residence is       . 18. The child(ren)/ward(s)’s father is       and the child(ren)/ward(s)’s mother is       , whose maiden name is       . 19. The child(ren)/ward(s)’s date of birth and place of birth are as follows: Child’s name Date of Birth Place of birth                                                                                           20. The child(ren)/ward(s) have no felony conviction records, and are not currently incarcerated or a probationer with any court. 21. The child(ren)/ward(s) have never previously had a change of name. 22. The petitioner(s) desire(s) a change of name for the following reasons:       . 23. This change of name is not sought for any fraudulent purpose and will not infringe on the rights of another. ______________________ _________________ Signature of Petitioner Daytime Phone Number       ______________________ _________________ Signature of Petitioner Daytime Phone Number       2 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 is signed to the foregoing Petition, and acknowledged the same under oath before me. Given under my hand and seal this       day of       ,       . __________________________________ My Commission Expires:       Deputy Clerk/ Notary Public 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 is signed to the foregoing Petition, and acknowledged the same under oath before me. Given under my hand and seal this       day of       ,       . __________________________________ My Commission Expires:       Deputy Clerk/ Notary Public