STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 22nd JUDICIAL CIRCUIT McHENRY COUNTY IN THE MATTER OF THE PETITION OF ________________________________________________, a Minor by______________________________________________, Case Number______________________________________ Parent or Guardian FOR CHANGE OF NAME VERIFIED PETITION FOR NAME CHANGE (MINOR) _____________________________________________________________________, Parent(s) or Guardian of minor ___________________________________________________________ respectfully requests that this Court find that it is in the best interest of the minor that his/her name be changed according to the provisions of 735 ILCS 5/21-101 et seq. and order that the name change take place. In support of this Petition, Petitioner(s) represent(s) as follows: 1. The minor now bears the name of _______________________________________________________________________. 2. Petitioner(s) request(s) that the minor’s name be changed to ___________________________________________________. 3. The minor is a resident of McHenry County, State of Illinois, and has been a resident of this State for at least six months immediately preceding the date of this Petition. 4. The Petitioner(s) is/are the parent(s) of said minor. The Petitioner is and has been the guardian of the minor since _____________________________. Guardianship was received through _____________________________________________________________________________________ ___________________________________________________________________________________________________ 5. Notice of the hearing on this Petition will be given to the following persons who are parents of the minor child whose parental rights have not been terminated or are persons who have physical custody of the child: Name Address ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 6. Notice of the hearing will be given to the person(s) listed in paragraph 5, pursuant to 735 ILCS 5/21-101 et seq. Proof of service of such notice shall be filed by the time of the hearing. CV-PET4: Revised 1/14/08 page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com 7. It is in the best interest of the minor that his/her name be changed for the following reasons: WHEREFORE the Petitioner(s) respectfully request(s) that this minor’s name be changed from its current form to _____________________________________________________________________ as provided by 735 ILCS 5/21-101 et seq. _______________________________________________________________ Petitioner’s Signature Relationship to Minor _______________________________________________________________ Petitioner’s Signature Relationship to Minor AFFIDAVIT ___________________________________________, being duly sworn on oath states that he/she is the Petitioner in the foregoing matter; that he/she is familiar with all the statements contained in this Petition and that the statements set forth herein are true and correct in substance and fact. _______________________________________________________________ Petitioner’s Signature Relationship to Minor SUBSCRIBED AND SWORN to before me ________________________________________, 20_____ ________________________________________________ Notary Public AFFIDAVIT ___________________________________________, being duly sworn on oath states that he/she is the Petitioner in the foregoing matter; that he/she is familiar with all the statements contained in this Petition and that the statements set forth herein are true and correct in substance and fact. _______________________________________________________________ Petitioner’s Signature Relationship to Minor SUBSCRIBED AND SWORN to before me Name_____________________________________________ ________________________________________, 20_____ ARDC Number______________________________________ ________________________________________________ Notary Public Attorney for_________________________________________ Address_____________________________________________ City, State Zip________________________________________ Phone_______________________________________________ CV-PET4: Revised 1/14/08 page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com