STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 22nd JUDICIAL CIRCUIT McHENRY COUNTY IN THE MATTER OF THE PETITION OF ________________________________________________ FOR CHANGE OF NAME Case Number______________________________________ VERIFIED PETITION FOR NAME CHANGE (ADULT) Now comes Petitioner, ____________________________________________, and respectfully requests that this Court enter an order that his/her name be changed. In support of this petition, Petitioner states as follows: 1. Petitioner desires to change his/her name pursuant to 735 ILCS 5/21-101 et seq. 2. Petitioner now bears the name _______________________________________________________________ and seeks to assume the name of _________________________________________________________________________________. 3. Petitioner is a resident of the County of McHenry, State of Illinois, and has been a resident of the State of Illinois for more than six months prior to filing this petition. 4. Petitioner has never been convicted of a felony. Petitioner has been convicted of a felony, but it has been over ten (10) years since the completion and discharge from his/her sentence. 5. Petitioner will serve notice of the petition and hearing by publication in the _____________________________ newspaper. This newspaper is published in the municipality in which the Petitioner resides, or there is no newspaper published in the municipality in which the petitioner resides and this newspaper is published in McHenry County. A copy of the publisher’s certificate will be filed prior to the date of hearing. WHEREFORE the Petitioner respectfully requests that his/her name be changed from __________________________________ ____________________ to ________________________________________________________________________________. ________________________________________________________________ Petitioner’s Signature AFFIDAVIT ___________________________________________, being duly sworn on oath states that he/she is the Petitioner in the foregoing matter; he/she is familiar with all the statements contained in this Petition and that the statements set forth herein are true and correct in substance and fact. ________________________________________________________________ Petitioner’s Signature Name_________________________________________ SUBSCRIBED AND SWORN to before me ARDC Number_________________________________ ______________________________________, 20______ Attorney for____________________________________ _______________________________________________ Notary Public Address_______________________________________ City, State Zip__________________________________ Phone_________________________________________ CV-PET3: Revised 1/14/08 American LegalNet, Inc. www.FormsWorkflow.com