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 American LegalNet, Inc. www.FormsWorkFlow.com 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:___________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com