Fill and Sign the West Virginia Name Change Form

IN THE ____________ COURT OF __________________ COUNTY WEST VIRGINIA IN THE MATTER OF:       Civil Action No. ______________ FOR A CHANGEOF NAME TO       PETITION FOR CHANGE OF NAME COMES PETITIONER:       and, pursuant to West Virginia code §48-25-101, and by this petition, and upon being duly sworn, respectfully represents and shows unto the Court: 1. That the Petitioner named above is a bona fide resident of this county and state and has been such for at least one year prior to the filing of this Petition; 2. That the Petitioner requests the following change of name: FROM TO             5. That the reason the Petitioner requests a change of name is:                   6. That a certified copy of Petitioner’s birth certificate is attached hereto; 7. That the requested change of name is not for purposes of avoiding debt or creditors; 8. That the Petitioner is not a registered sex offender pursuant to any state or federal law; Petition for Change of Name - 1 - 9. That the requested change of name is not for purposes of avoiding any state or federal law regarding identity; 10. That the requested name change is not for any improper or illegal purpose; 11. That the Petitioner is not a convicted felon in any jurisdiction; 12. That the requested name change is not for any purpose of evading detection, identification or arrest by any local, state or federal law-enforcement agency; and 13. That Petitioner is not aware of any persons who might be injured by reason of the name change. WHEREFORE , based upon the foregoing, and upon a hearing to be held in this matter, the undersigned Petitioner requests the Court grant the name changes as stated above, and such other relief the court finds appropriate. Dated this ______ day of ________________________ , 20 ______ . VERIFICATION STATE OF WEST VIRGINIA COUNTY OF ________________, to-wit: I,       , on oath or affirmation, say that I am a/the petitioner named in this PETITION and that the facts contained herein are true, except that where they are stated to be on information and belief, I believe them to be true. ____________________________________ PETITIONER Taken, subscribed, and sworn or affirmed before me this _____ day of ______________, 20_______. My commission expires: .______________________________ ____________________________________ Notary Public Petition for Change of Name - 2 -