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Application For Change Name Minor Form. This is a Connecticut form and can be use in Probate Statewide.
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Tags: Application For Change Name Minor, PC-900, Connecticut Statewide, Probate
APPLICATION FOR
RECORDED:
STATE OF CONNECTICUT
CHANGE OF NAME (MINOR)
COURT OF PROBATE
PC-900 REV. 7/12
[Type or print in black ink. Complete Confidential Information Sheet for PC-900 on next page.]
TO: COURT OF PROBATE,
DISTRICT NO.
DATE OF APPLICATION
IN RE CHANGE OF NAME OF
PETITIONING PARENT/GUARDIAN:
MOTHER
FATHER OR
NAME:
GUARDIAN
TELEPHONE NUMBER:
PRESENT ADDRESS:
NAME, ADDRESS, AND TELEPHONE NUMBER OF ANY NON-PETITIONING PARENT/GUARDIAN:
Check any boxes that apply:
The NON-PETITIONING parent and the petitioning parent:
There is an outstanding superior court order for
are divorced
visitation
have never been married.
child support.
To the best knowledge and belief of the petitioner, there is
a
no proceeding pending or contemplated in another court affecting the
custody of the minor child. [If such a proceeding is pending or contemplated, attach completed JD-FM-164, Affidavit Concerning Children.]
Explain why the non-petitioning parent is not joining in this petition:
MOTHER
CO-PETITIONER:
FATHER
NAME:
PRESENT ADDRESS:
TELEPHONE NUMBER:
MINOR PETITIONER(S) THROUGH PARENT(S) AS NEXT FRIEND [Give name(s), new name(s), and date(s) and place(s) of birth.]
NAME: First
Middle
CHANGED TO: First
Last
Middle
Last
PRESENT ADDRESS:
DATE OF BIRTH AND PLACE OF BIRTH:
NAME: First
Middle
CHANGED TO: First
Last
Middle
Last
PRESENT ADDRESS:
DATE OF BIRTH AND PLACE OF BIRTH:
A change of name is sought for the following reasons:
The petitioner(s) represent(s) that the purpose of seeking a change of name is not to deceive, defraud, or mislead any person or
governmental agency but solely for the reason(s) stated above.
WHEREFORE, the petitioner(s) as indicated above, request(s) a change of name to the name(s) stated above.
The representations contained herein are made under the penalties of false statement.
SIGNED: PETITIONER..............................................................................................
Date:
CO-PETITIONER .....................................................................................................
Date:
APPLICATION FOR CHANGE OF NAME (MINOR)
PC-900
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CONFIDENTIAL
STATE OF CONNECTICUT
DO NOT RECORD
INFORMATION SHEET
FOR PC-900, Application for
COURT OF PROBATE
[Type or Print in Black Ink.]
Change of Name (Minor)
NEW 7/12
_____________________________________________________________________________________
Court of Probate, ______________________________________________ District
The social security number(s) of the following minor child/children are required in connection with
this proceeding for change of name:
1) Minor child petitioning through parent as next friend:
Name:__________________________________________________________________
Social Security Number:____________________________________________________
2) Minor child petitioning through parent as next friend:
Name:__________________________________________________________________
Social Security Number:___________________________________________________
3) Minor child petitioning through parent as next friend:
Name:__________________________________________________________________
Social Security Number:___________________________________________________
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