: : Plaintiff(s) -againstIN THE MATTER OF: Index No. Calendar No. : : : JUDICIAL SUBPOENA * IN THE * CIRCUIT COURT : (child's current name) * FOR Defendant(s) * : . . . . . . . . .FOR .CHANGE .OF NAME. TO: . . . . . . . . . . . . . . . * . . . . . . ... ....... ....... ... . * (child's new name) * * BY AND THROUGH HIS/HER THE PEOPLE OF THE STATE OF NEW YORK MOTHER/FATHER/GUARDIAN: (petitioner's name) TO * * * * * Civil No.: * * * * * * * * * * * GREETINGS: CONSENT TO CHANGE OF NAME (Consent of Parent, Guardian or Custodian) (DOM REL 63) 1. Name, Age and Competence. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court My name is located at . My date of birth is County of in room and I am on the of understanding what this consent means. in the , capable day of , 20 , at o'clock noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the 2. Status as Parent or Guardian. Your failure to comply with this subpoena is punishable as a contempt of court and will name of child) liable to (current make you the party on whose behalf this subpoena was, issuedon a maximum penalty of $50 and all damages sustained as a for born , . result of your failure to comply. (date of birth) I am [ ] the mother [ ] the father (or) [ ] the guardian of 3. Consent. Witness, Honorable , one of the Justices of the I hereby consent that of minor child's name be changed from Court in County, day the , 20 (current name of child) to . I hereby join in the foregoing Petition and waive notice of process. I acknowledge that I have the right to revoke my consent at (Attorney must sign above and type name below) any time prior to the date an order changing the child's name is entered. I acknowledge that I was provided the opportunity to consult with legal counsel, if I so chose, before signing this Consent. Attorney(s) for I SOLEMNLY AFFIRM under the penalties of perjury that the contents of the foregoing Consent are true to the best of my knowledge, information, and belief. (date) Office (your signature) and P.O. Address (your name - PRINTED) (street address) Telephone No.: Facsimile No.: (city , state , zip code) E-Mail Address: (telephone number) Mobile Tel. No.: NOTE: Changing the name of a child will not change an existing child support obligation. Page 1 of 1 American LegalNet, Inc. www.USCourtForms.com DR 63 - Revised 13 Feb 2001