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Petitioner makes the following declaration: 1. Birth Date and Place: The minor was born on ____________, ________ in _____________ [city], ___________ [county], _________________ [state]. A certified copy of minor's birth certificate is attached to this petition. 2. Birth Name: The minor was named ___________ at birth, and as of the date of this minor, the minor has always been known by that name, with the following exceptions, if any: 3. Residence: The minor resides at ____________ [insert the minor's residential address] and has lived at this address for ____ [insert length of time in months or years at this address]. 4. Petitioner's Parents: The father of the minor is named _________, and he resides at _________ [insert residential address of father]. The mother of the minor is named _____________, and she resides at ____________ [insert residential address of mother]. 5. Reason for Name Change: Petitioner(s) seeks to change the minor's name to ________ and offers the following reason(s) for seeking to do so: 6. Legal and Creditor Status: The minor does not have any outstanding judgments, has never been convicted of a crime, and is not involved in any pending legal actions. 7. Additional Declarations: In addition to the foregoing statements, the Petitioner(s) further declares: NOW, THEREFORE, the Petitioner requests that the court order the minor's name to be changed as follows:
I, _____________________ [name of Petitioner], affirm under penalty of perjury that I am the Petitioner in the foregoing Petition to Change Name of Minor and that all statements in this Petition are accurate to the best of my knowledge.
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