STATE OF ILLINOIS COUNTY OF MCLEAN ) )SS ) IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT, COUNTY OF MCLEAN, ILLINOIS IN THE MATTER OF THE PETITION OF ) ) ___________________________________ ) A Minor by Parent or Guardian ) ) ___________________________________ ) For Change of Name CASE #_________________ 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 entitiled to notice through the local Sheriff or other authorized person. Other (explain) _________________________________________________________ __________________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com 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 of Guardian/Parent (if under 18) ____________________________________ Petitioner Father or Guardian/Parent (if under 18) STATE OF ILLINOIS COUNTY OF MCLEAN ) )SS ) __________________________________________, 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 American LegalNet, Inc. www.FormsWorkflow.com