Free Petition for Family Change of Name - New York

Civil Court of the City of New York
County of In the Matter of the Application of Index Number PETITION FOR FAMILY CHANGE OF NAME

for Leave to Change Their Name(s) To

(and Primary Adult 1. 2. The present family name is: (Second Adult, if any)

), by this petition, allege(s)

The new name which we propose to assume in place and stead of the present name is:

3.

The individuals* whose names are included in this application are incorporated herewith are as follows:

Present Name

Proposed Name

Place of Birth

Date of Birth

Present Age

*Primary Adult (and Secondary Adult, if any) and all minors under the age of 18 should he listed. Minors between the ages of 14 and 18 must consent to this change by signing the Consent on page 2.

4.

Has any applicant been convicted of a crime, adjudicated a bankrupt, or are there any judgments or liens against any applicant, or are there any actions or proceedings pending against any application, or does any applicant have any obligations for child support and/or spousal support? NO YES* *If the answer to any part of this question is YES for any applicant, each applicant who answers YES must fill out a CIV-GP-82F supplemental form. Our present residence is: The reasons for this application are as follows:

5. 6.

7.

WHEREFORE, your Petitioner(s) respectfully request(s) that an Order be granted permitting this requested change of name.

Date

Signature of Petitioner

Signature of Second Adult CIV-GP-82F Page 1 (Revised November, 2006)

CONSENTS I, am 14 years of age or over, and less than 18 years of age, and I have read the annexed petition for family change of name, and I consent to the same.
,

Date
,

Signature

I, am 14 years of age or over, and less than 18 years of age, and I have read the annexed petition for family change of name, and I consent to the same. Date
,

Signature

I, am 14 years of age or over, and less than 18 years of age, and I have read the annexed petition for family change of name, and I consent to the same. Date
,

Signature

I, am 14 years of age or over, and less than 18 years of age, and I have read the annexed petition for family change of name, and I consent to the same. Date VERIFICATION State of New York County of ss.: Signature

, being duly sworn, deposes and say(s): s/he/they is (are) the petitioner(s) named above, that s/he/they has/have read the petition and know(s) the truth of the contents thereof except for those matters alleged to be on information and belief, and as to those matters, s/he/they believe(s) them to be true, and that the signature(s) of the consenting party (parties) above is/are the true signature(s) of the minor child(ren) who is/are included in the petition.

Signature of Petitioner

Signature of Second Adult

Sworn to before me this

day of

20

Sworn to before me this

day of

20

Signature of Notary Public

Signature of Notary Public

CIV-GP-82F Page 2 (Revised November, 2006)
FREE CIVIL COURT FORM No fee may be charged to fill in this form. Form can be found at: http://www.nycourts.gov/courts/nyc/civil/forms.shtml.