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Petition For Name Change (Adult) Form. This is a Illinois form and can be use in Lake Local County.
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Tags: Petition For Name Change (Adult), CV20, Illinois Local County, Lake
IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT
LAKE COUNTY, ILLINOIS
IN THE MATTER OF THE PETITION OF
For Change of Name
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Gen. No.
PETITION FOR NAME CHANGE (ADULT)
To the Honorable Judge of the above-named Court;
respectfully represents as follows:
Your Petitioner
1. That Petitioner desires a change of name, according to the provisions of 735 ILCS 5/21-101 et. seq.
, by
2. That Petitioner now bears or holds the name of
which he / she has been and now is known and called, and he / she seeks to assume the name of
, by which he / she may hereafter be known and called.
3. That he / she is a resident of the State of Illinois and the County of Lake in said State, and has been a
resident of said state for more than six months past.
, County of
4. That he / she was born in the City of
and State/Country of
.
5. That Petitioner has given due notice of his / her intended application, by publication in the
, a newspaper of general circulation published in Lake County,
for three (3) consecutive weeks, a copy of which published notice with the publisher’s certificate
thereon is attached hereto, marked “Exhibit A”, and made a part hereof.
6. That Petitioner has not in any state ever been convicted of identity theft, aggravated identity theft,
felony or misdemeanor criminal sexual abuse when the victim of the offense at the time of its
commission was under 18 years of age, felony or misdemeanor sexual exploitation of a child, felony or
misdemeanor indecent solicitation of a child, felony or misdemeanor indecent solicitation of an adult,
or any other offense for which a person is required to register under the Sex Offender Registration Act
in this state or any other state who has not been pardoned.
7. That Petitioner has not in any state been convicted of any other felony not listed in paragraph 6, unless
10 years have passed since completion and discharge from his or her sentence or been pardoned.
Wherefore, Petitioner prays that his / her name be changed from its current form to
as provided by 735 ILCS 5/21-101 et. seq.
Petitioner
, being duly sworn on oath says that he / she is
the Petitioner in the foregoing matter; that he / she is familiar with the matters therein contained and that
the statements set forth herein are true and correct in substance and in fact.
Subscribed and sworn to before me
this
day of
Petitioner
, 20
.
Notary Public
CV/20
171-114 (R 12/06)
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