SUPERIOR COURT OF FULTON COUNTY STATE OF GEORGIA In re the Name Change of: , Civil Action Case Number Petitioner. PETITION TO CHANGE NAME OF ADULT My name is and I am representing myself in this petition. In support of my case, I state the following: 1. 2. I reside in FULTON County, Georgia. Therefore, jurisdiction and venue are proper in this Court. I was born on __ (a) in : [Check and complete only one of the following.] County, State of , U.S.A. . to . __ (b) outside the United States, in 3. I want to change my name from 4. [Explain here why you want to change your name.] The reasons for this name change are as follows: Petition to Change Name of Adult -- Rev. Oct. 2015 Provided by the Fulton Family Law Information Center American LegalNet, Inc. www.FormsWorkFlow.com 5. I do not intend to use this name change to fraudulently deprive anyone of any right under the law. THEREFORE, I ask: (a) (b) That my name be changed as provided in Paragraph 3 above; That notice of this Petition be served as provided by law. Dated: Petitioner, Pro se (Signature) Name: Address: Email: ______________________________ IF YOU DO NOT HAVE AN EMAIL ADDRESS, FILL OUT A CERTIFICATE OF NO EMAIL ADDRESS Telephone No.: _____________________________ Petition to Change Name of Adult -- Rev. Oct. 2015 Provided by the Fulton Family Law Information Center American LegalNet, Inc. www.FormsWorkFlow.com