CV-451, 05/19 Petition for Confidential Name Change for Adult or Minor 14 or Older 247247301.45, 786.36 and 786.37, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materials Enter the name of the county in which this case was filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter your current name. You are the Petitioner . IN THE MATTER OF T HE CONFIDENTIAL NAME CHANGE OF First Name Middle Name Last Nam e The clerk will enter the case number . Amended P etition f or Confidential Name Change for Adult or Minor 14 or Older (30708) Case No. I am the p etitioner and state: In 1, enter your complete address. 1. My address is [Street Address, City, State and Zip] In 2, enter the county that you live in. 2. I live in County , Wisconsin . In 3 , enter the date and state of your birth. 3 . I was born on [Date ] in the state of . In 4, enter the state that the birth certificate was issued. 4 . My birth certifi cate was issued in the state of . In 5, enter the name as it appears on the birth certificate. 5. T he name that appears on my birth certificate is [First Name] [Middle Name] [Last Name] In 6 , enter your job title . 6 . My current job is . In 7 , check a or b. 7 . a. I do not work in a job for which a license has been required by any state, or my only professional license is to teach in the public schools in this state. b. I do work in a job (other than a licensed teacher in Wisconsin public schools) for which a license has been required by any state. However, I have notified the state board or commission for my profession and they do not object to my proposed name change. In 8 , check the appropriate box. 8 . I am am not a convicted sex offender required to register under 247247301.45, 938.34(15m), and 938.345(3), Wis consin Statutes or a similar law of any other state. In 9 , enter reasons why you want your name change confidential. 9 . I request that this petition remain confidential because publication could endanger me for the following reason ( s ) : In 10 , enter your proposed new name. 10 . I have not petitioned for a name change to avoid a debt or conceal a criminal record. I wish to change my name to [ First Name] Enter the reason(s) you want to change your name. [ Middle Name(s )] [Last Name] For the following reason(s): Check 11, if you want your name changed on your WI birth and/or marriage certificate. 11. I wish to change the name on my Wisconsin birth marriage certificate. I declare under the penalty of false swearing that the information I have provided is true and accurate. Signature Print or Type Name Date American LegalNet, Inc. www.FormsWorkFlow.com