IN THE MATTER OF:
Your Current Name
Street Address
City, State, Zip
Telephone
IN THE
CIRCUIT COURT
FOR
Civil No.:
FOR CHANGE OF NAME TO:
New Name
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PETITION FOR CHANGE OF NAME
(Adult)
(DOM REL 60)
TO THE HONORABLE, THE JUDGE OF SAID COURT:
Your Current Name
My name has been changed to the following since birth for the following reasons:
(List any reasons why your name may have changed since birth, for example, marriage).
Name Changed To: Reason:
I have attached any documents that changed my name officially.
DR 60 (Rev. 9/2005)
Page 1 of 2
Petitioner,
, respectfully represents
to this Court:
1. That I was born on
, in
,
Your Birthdate
Your Birthplace - City, State, County
and presently reside at
Present Address
2. That I was born
Your Birth Name
attached birth certificate.)
. (See copy of
3. Select one of the following:
I have never registered as a sexual offender; OR
I am or have previously been registered as a sexual offender under the following name:
4. I am requesting this change of name because:
5. I wish to change my name to:
.
Full Name as Registered
New Name
6. I hereby certify that the above change of name is not requested for any illegal or
fraudulent purposes.
WHEREFORE, I respectfully request that the Court pass an Order changing my name
from to
.
Current Name
New Name
I, , solemnly affirm under the penalties of
perjury, that the contents of the foregoing paper are true to the best of my knowledge,
information and belief.
DR 60 (Rev. 9/2005)
Page 2 of 2
Your Current Name
Date
Your Signature
Your Name - Printed
Address
Cit