eForm: Petition for Change of Name (Adult--no dissolution of marriage) *Caution: this form requires protected information and the filing of a separate Protected Information Form. In the Iowa District Court for ________________ County Petition for Change of Name (Adult--no dissolution of marriage) In re the Name Change of: ___________________________________ Petitioner If you need assistance to participate in court due to a disability, contact the disability coordinator (information at www.iowacourts.gov/Representing_Yourself/ADAAccess). Persons who are hearing or speech impaired may call Relay Iowa TTY (1-800-735-2942). Disability coordinators cannot provide legal advice. Petitioner, for this Petition for Change of Name under Iowa Code chapter 674, states: 1. Petitioner's present full name is _______________________________________________, and petitioner resides in ________________________________ County, Iowa. 2. Petitioner is ____ feet, ____ inches tall; weighs______ lbs.; has __________ color hair; and _____________ color eyes. 3. Petitioner is a _________________ (race) _________________ (female/male) who was born in _________________________________ (place) on ______________________ (date)*. 4. Petitioner owns the following real property in Iowa (provide legal description): 5. Petitioner currently resides at__________________________________________________. and has also resided at the following prior addresses during the past five years: Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 6. Petitioner is (check one): unmarried or married. (If married, petitioner must give legal notice to the spouse of the filing of this petition.) 7. Petitioner desires a name change for the following reasons: 8. Petitioner has not previously requested a name change pursuant to Iowa Code chapter 674. 9. Check either A or B: *A. A certified copy of petitioner's birth certificate is filed with this petition. Or, B. A certified copy of petitioner's birth certificate is not available because (state reasons birth certificate is not available): 10. If petitioner's birth certificate is not available, petitioner must file another form of identification in place of the certified copy of the birth certificate. Such other form of identification may include documents provided by the United States department of immigration and naturalization service. 11. Petitioner requests the court to enter an order changing petitioner's name: From (present full name) _______________________________________ To (requested new name) ______________________________________ I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the preceding is true and correct. Date: __________________________ ___________________________________ Telephone number ________________________________ Signature of Petitioner /s/ __________________________________ Printed name ___________________________________ Email address ____________________________________ Mailing address ________________________________ Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com