Change of Name CHNGNAME(08/00) UNITED STATES OF AMERICA STATE OF ILLINOIS COUNTY OF LASALLE IN THE CIRCUIT COURT OF THE THIRTEENTH JUDICIAL CIRCUIT IN THE MATTER OF THE PETITION OF Case No. _____________ For change of name CHANGE OF NAME TO THE HONORABLE JUDGE OF THE CIRCUIT COURT Your petitioner _______________________________________ respectfully shows that _________________ (is/are) a resident of the State of Illinois, and (has/have) resided in the County of LaSalle in said state for more than 6 months prior to the filing of this petition; that __________ desires to change ________ name, according to the provisions of the Statute in such case made and provided, and ________ now, in that behalf, respectfully shows that _____ now bears the name of __________________________________________________________________ and is known and called by this name; that ______________ desires to assume the name of by which may be hereafter known and called. That ________________ respective place of nativity and age is as follows: _________________________________________________________________________________________________ That _____ (has/have) resided in the State of Illinois for _______ years last past. That ________ (has/have) given notice of this, ________ intended application by publication in ______________________________________________ a newspaper published in LaSalle County of general circulation, for three consecutive weeks, a copy of which published notice, with the certificate of the publisher thereon is hereto annexed and made part of this petition. WHEREFORE, Your petitioner prays, the premises being considered, that ________ name be changed from its present form to ___________________________________________________________________________________ as provided by Statute, and that ______ hereafter be known and called by the last aforesaid name, and that ______ (has/have) such other or future relief in the premise as this Honorable Court shall seem met, according to law. _____________________________________________ Name: __________________________________________________ Attoney for Petitioner(s) Address: ________________________________________________ __________________________________________________ City: _____________________________________________________ ____________________________________________________ Phone: _________________________________________________ __________________________________________________ ________________________________________________________________________________ AFFIDAVIT being duly sworn on oath deposes and says that (is/are) acquainted with ____________________________________________________________________________________________ the petioner in this cause, who has signed this petition; that ________________ (has/have) hereby read this petition, and knows the contents thereof, and that the same, and the matters and things herein stated are true. _____________________________________________________ Affiant Sworn and Subscribed to before me _______________________________________, 20___________ Notary Publc - Court Clerk ________________________________________________________________________________ LASALLE COUNTY CIRCUIT CLERK OTTAWA, ILLINOIS 61350 American LegalNet, Inc. www.USCourtForms.com