Free State of Minnesota - Minnesota

State of Minnesota
County

District Court
Judicial District: Court File Number: Case Type: Name Change

Select County
In the Matter of the Application of:

First

Middle

Last

On Behalf of (current name of minor(s)):

Order Granting Name Change of a Minor (Minn. Stat. § 259.10)

First

Middle

Last

For a change of name to (new name of minor(s)):

First

Middle

Last

The above entitled matter came on for hearing before the undersigned Judge on _________________________ upon
Date

the Application for a Name Change of a Minor(s). Upon the testimony and files, THE COURT FINDS the following: 1. The application is made in good faith without intent to defraud or mislead. 2. Each minor child who is seeking a name change has lived in the State of Minnesota for at least six months preceding the filing of the application, and now lives at:
No. Street

in
City/Town State Zip

County. of the minor child (ren).

3. The applicant is the:

parent

legal guardian

next of kin (specify):

4. Name of each of minor child and date(s) of birth:

5. The name of the non-applicant parent(s): The non-applicant parent(s) is/are not known and his/her/their name(s) is/are not shown on the birth certificate. 6. The non-applicant parent(s) has/have received application for name change of the minor(s). actual notice published notice of the pending of the

7. The applicant requests to have the name(s) of each minor child changed to:

8. A. The minor child (ren) has/have not been convicted of a felony in any state. B. The minor child (ren) has/have been convicted of a felony as follows: AND Proper notice has been given to the prosecuting authority and Minnesota Attorney General AND No objection has been filed.

NAM208

State

ENG

Rev 12/06

www.mncourts.gov/forms

Page 1 of 2

9. Legal description of lands in the State of Minnesota upon which the following minor child (ren) has/have claim(s), interest, or lien(s): (Provide the legal description and attach additional pages if necessary.)

10.

The change of name is in the best interest of the minor child (ren.)

11. Other: . The application is granted and IT IS ORDERED that: The name(s) of the minor(s) shall be
All persons having a criminal history who have been granted a name change by this court have a duty to report that name change to the Bureau of Criminal Apprehension within ten (10) days of this order.

Other

Dated: Judge of District Court

DUTY TO REPORT NAME CHANGE Minn. Stat. § 259.11B If you have a criminal history and have changed your name, you have a duty to report your name change to the Bureau of Criminal Apprehension located at 1430 East Maryland Avenue, St Paul, MN 55106, (651)793-2400, within ten (10) days of this order. Failure to do so is a gross misdemeanor punishable by up to one (1) year in prison and/or a fine of $3000.

NAM208

State

ENG

Rev 12/06

www.mncourts.gov/forms

Page 2 of 2