JDF 433 R 3 - 1 8 PETITION FOR CHANGE OF NAME (ADULT) County Court District Court County, Colorado Court Address: I n the Matter of the Petition of : F or a Change of Name to : COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION FOR CHANGE OF NAME (ADULT) 1. My current full name is First Name Middle Name Last Name 2. I wish to change my name to First Name Middle Name Last Name 3. My date of birth is . 4. I am 18 years of age or older. 5. I am a resident of County. 6. I have not been convicted of a felony or adjudicated a juvenile delinquent for an offense that would constitute a felony if committed by an adult in this state or an y other state or under federal law. My certified, fingerprint - based criminal history record check from the FBI is attached as Exhibit A and my certified, fingerprint - based criminal history record check from the CBI is attached as Exhibit B . Both are dated within 90 days of the filing of this Petition pursuant to 24713 - 15 - 101(b), C.R.S. 7. I am requesting a name change for the following reason(s): 8. The proposed change of name would be proper and not detrimental to the interest of any other person. 9. I ask the Court to order publication of my name change request as required by 247 13 - 15 - 102, C.R.S. Or Publication of my name change request is not required for the following reason(s): By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. American LegalNet, Inc. www.FormsWorkFlow.com JDF 433 R 3 - 1 8 PETITION FOR CHANGE OF NAME (ADULT) VERIFICATION AND ACKNOWLEDGEMENT I swear/affirm under oath that I have read the foregoing Petition and that the statements set forth therein are true and correct to the best of my knowledge. (Printed name of Petitioner) Signature of Petitioner Address City, State, Zip Code Telephone #: (home) (work) (cell) Signed and sworn to before me by in the County of , State of , this , day of , 20 . My Commission Expires: Deputy Clerk/Notary Public American LegalNet, Inc. www.FormsWorkFlow.com