STATE OF ILLINOIS) )SS COUNTY OF WILL ) IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY, ILLINOIS IN THE MATTER OF THE PETITION TO CHANGE THE NAME(S) OF________________________________________ ____________________________________________________ TO_________________________________________________ CASE NO:______________________ ____________________________________________________ PETITION The undersigned Petitioner(s), on behalf of (himself) (herself) and (spouse) as the (parent) (guardian) of _______________________, ____________________________,__________________________,_________________ (minor) (adult) alleges: 1. That (she) (he) (they) (and the adult ) (minor) children)) (has) (have) resided in the State of Illinois since more than six (6) months last past and presently reside(s) at ___________________________________________________; that the date and place of birth of Petitioner(s) and said (adult) (minor) child(ren) is as follows: NAME DATE OF BIRTH PLACE OF BIRTH 2. That Petitioner has never been convicted of a felony, misdemeanor criminal sexual abuse when the victim of the offense at the time of its commission is under 18 years of age, misdemeanor sexual exploitation of a child, misdemeanor indecent solicitation of a child, or misdemeanor indecent solicitation of an adult in this State or any other state. 3. That_______________________________________, minor, has resided in the family of Petitioner and has been recognized and known as an adopted child in the family of Petitioner(s). 4. That the change of name requested is in the best interest of the (adult) (minor) for the following reasons:_________ ________________________________________________________________________________________________ 70 (Revised 1-00) 2 Sided Form CVPCN American LegalNet, Inc. www.USCourtForms.com 5. That the name and address of the natural parents of the minor (child) (children) is as follows: NAME ADDRESS 6. That the consents of the natural parents are attached heretofore or that previous notice of the presentation of this petition has been given to said parents given as follows: 1. Publication in a newspaper for three (3) consecutive weeks, the first insertion at least six (6) weeks prior to the presentation of this petition. 2. Service of notice by certified mail. 3. Service of process by the Sheriff of the County of the parents residence. 4. Personal service of notice by Petitioner. WHEREFORE, Petitioner requests (his) (her) name and the name(s) of _____________________________________ ______________________________________________________ be changed from ____________________________ ___________________________________________________ to____________________________________________ ___________________________________________________. _________________________________________ Petitioner _________________________________________ Petitioner ________________________________ being first duly sworn on oath states that (she) (he) is the Petitioner in the foregoing petition and that (she) (he) has read the same and that the contents thereof are true. ________________________________________ Petitioner ________________________________________ Petitioner Subscribed and sworn to before me the _______ day of ________________________, 20_______. ________________________________________ Notary Public/Judge American LegalNet, Inc. www.USCourtForms.com