PETITION FOR CHANGE OF NAME ( single / plural) 3253 (Rev. 01/08) UNITED STATES OF AMERICA IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT STATE OF ILLINOIS COUNTY OF DU PAGE IN THE MATTER OF THE PETITION OF CASE NUMBER FOR CHANGE OF NAME File Stamp Here PETITION FOR CHANGE OF NAME ( single / plural) TO THE HONORABLE JUDGE OF THE CIRCUIT COURT Your petitioner(s) respectfully show as a resident(s) of the State of Illinois and have resided in said State for six (6) months prior to the filing of this petition; having been a resident of the State of Illinois since born in state / county . Your petitioner(s) who were desire to change name(s) according to the provisions of 735 ILCS 5/21 in such case made and provided, and now, in that behalf, respectfully show and now bears the name of : and are known and called by this name; and desire to assume the name of: by which may afterward be known and called. That given notice of this intended application by publication for three (3) successive weeks in a newspaper of general circulation, published in DuPage County, a copy of said published notice, with the certificate of the publisher thereon is hereto annexed and made part of this petition. WHEREFORE, your petitioner(s) pray(s), the premises being considered and name(s) be changed from it's present form to: as provided by statute, and that such other or future relief in the premises as this Honorable Court shall deem met, according to law. Name: PRO SE DuPage Attorney Number: Date Date Petitioner Attorney for: Petitioner Address: City/State/Zip: Telephone Number: AFFIDAVIT being duly sworn on oath deposes and says that they are acquainted with the petitioner(s) in this cause, who have signed this petition; and that have hereby read this petition, and knows the contents thereof, and that the same, and the matters and things herein stated are true. Signed and sworn to before me Date Circuit Clerk or Notary Public CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT © WHEATON, ILLINOIS 60189-0707 Affiant American LegalNet, Inc. www.FormsWorkflow.com