STATE OF ILLINOIS ) ) SS COUNTY OF LAKE ) IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT, LAKE COUNTY, ILLINOIS IN THE MATTER OF THE PETITION OF ________________________________ A Minor by Parent or Guardian ________________________________ For Change of Name ) ) ) ) ) ) Gen. No. _______________ PETITION FOR NAME CHANGE (MINOR) To the Honorable Judge of the above-named Court; Your Petitioner _____________________________________ respectfully represents as follows: 1. That Petitioner desires a change of name, according to the provisions of 735 ILCS 5/21-101. 2. That Petitioner Minor now bears or holds the name of ______________________________, by 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 (a) the minor resides at _________________________________________________, (b) minor has lived in this State for _________________________________. 4. That said minor was born in the City of __________________, County of _______________ and State/Country of ________________________. 5. That Petitioner has given reasonable notice of hearing on this Petition to any parent of the minor child whose parental rights have not been previously terminated and any person who has physical custody of the minor child in the following manner: By mailing a copy of this Petition and Notice of hearing thereon to the last known address of each person entitled to notice by certified U.S. Mail, return receipt requested. By personally delivering a copy of this Petition and Notice of hearing thereon upon each person entitled to notice through the local Sheriff or other authorized person. CV/15 171-113 rev 2/02 pg 1 of 2 2002 © American LegalNet, Inc. Other (explain)_______________________________________________________ ______________________________________________________________________ Wherefore, Petitioner prays that the minor child’s name be changed from its current form to ___________________________________________________ as provided by 735 ILCS 5/21. ___________________________________ Petitioner Mother or Guardian/Parent (if under 18) ___________________________________ Petitioner Father or Guardian/Parent (if under 18) STATE OF ILLINOIS ) ) SS COUNTY OF LAKE ) ________________________________________, 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. ___________________________________ Petitioner ___________________________________ Petitioner Subscribed and sworn to before me this _____ day of _________________________, 20_____. ______________________________________ Notary Public CV/15 171-113 rev 2/02 pg 2 of 2 2002 © American LegalNet, Inc. MINOR CHANGE OF NAME 1. OBTAIN AND COMPLETE THE FOLLOWING FORMS: (A) PETITION FOR CHANGE OF NAME (2 COPIES) (B) DECREE OF CHANGE OF NAME (3 COPIES) (C) NOTICE OF MOTION (3 COPIES) NOTICE OF MOTION IS USED ONLY WHEN THE NATURAL PARENTS ARE NOT COHABITATING (D) NOTICE OF PUBLICATION (2 COPIES) NOTICE OF PUBLICATION IS USED ONLY WHEN THE WHEREABOUTS OF THE NON-CUSTODIAL PARENT IS UNKNOWN 2. WHEN BOTH PARENTS ARE IN AGREEMENT OF THE NAME CHANGE , BOTH APPEAR IN THE CIRCUIT CLERK’S OFFICE AT 8:30 AM ANY DAY EXCEPT THURSDAY 18 N. COUNTY STREET WAUKEGAN, IL 60085 (A) THE PARENTS WILL SUBMIT TO THE CLERK THE PETITION FOR CHANGE OF NAME AND PAY $222.00 CASH OR DISCOVER CARD, NO PERSONAL CHECKS ACCEPTED. (B) PARENTS WILL BE INSTRUCTED TO GO TO THE ASSIGNED COURTROOM. AFTER COURT, RETURN TO THE CIRCUIT CLERK’S OFFICE TO OBTAIN CERTIFIED COPIES OF THE DECREE ($5.00 FOR EACH COPY, CASH OR DISCOVER CARD, NO PERSONAL CHECKS). 3. IF THE PARENTS OF THE MINOR ARE NOT COHABITATING, THE CUSTODIAL PARENT MUST FILE THE PETITION ALONG WITH A NOTICE OF MOTION AND MAIL A COPY BY CERTIFIED MAIL TO THE NON-CUSTODIAL PARENT. AT THE TIME OF FILING THE PETITION, A COURT DATE WILL BE SET AND THE $222.00 FEE PAID IN CASH OR BY DISCOVER CARD, NO PERSONAL CHECKS. ON THE SET COURT DATE, PARENTS WILL APPEAR IN THE ASSIGNED COURTROOM. MAKE SURE ALL COPIES OF THE DECREE ARE COMPLETE AT THAT TIME. 4. WHEN THE WHEREABOUTS OF THE NON-CUSTODIAL PARENT IS UNKNOWN, THE CUSTODIAL PARENT MUST GO TO A NEWSPAPER TO HAVE THE CHANGE OF NAME REQUEST PUBLISHED. (PUBLICATION MAY BE IN ANY NEWSPAPER WITH GENERAL CIRCULATION THROUGHOUT LAKE COUNTY. CONTACT THE NEWSPAPER TO FIND OUT THE APPROPRIATE FEE THEY REQUIRE.) AT THAT TIME, THE PARENT WILL SELECT A COURT DATE SIX WEEKS FROM THE DATE OF THE FIRST PUBLICATION (NO THURSDAYS). THE NEWSPAPER WILL NEED THE “NOTICE OF PUBLICATION” FOUND IN THIS PACKET. ON THE COURT DATE SELECTED (WHICH WILL APPEAR IN THE PUBLICATION), COME TO THE CIRCUIT CLERK’S OFFICE AT 8:30 AM TO FILE THE PETITION, DECREE AND CERTIFICATE OF PUBLICATION (THE NEWSPAPER WILL HAVE SENT THE CERTIFICATE TO YOU), AND PAY THE FEE OF $222.00 IN CASH, OR DISCOVER CARD, NO PERSONAL CHECKS. AFTER FILING SUCH PAPERS, PROCEED TO THE ASSIGNED COURTROOM. AFTER COURT, OBTAIN CERTIFIED COPIES OF THE DECREE IN THE CIRCUIT CLERK’S OFFICE ($5.00 FOR EACH COPY, CASH OR DISCOVER American LegalNet, Inc. www.USCourtForms.com CARD, NO PERSONAL CHECKS). 5. CHANGING THE BIRTH CERTIFICATE TO THE NEW NAME: (A) IF BORN IN ILLINOIS, MAIL A CERTIFIED COPY OF THE DECREE AND A $15.00 MONEY ORDER TO: THE BUREAU OF VITAL STATISTICS STATE OF ILLINOIS-DEPARTMENT OF HEALTH SPRINGFIELD, ILLINOIS 62706 (B) IF BORN OUTSIDE OF ILLINOIS, CONTACT THE OFFICE WHICH KEEPS THE BIRTH RECORDS FOR THE STATE IN WHICH THE MINOR WAS BORN FOR PROCEDURES AND THE APPROPRIATE FEES. Rev 11/02 American LegalNet, Inc. www.USCourtForms.com