Consent To Change Of Name (Consent Of Parent Originally Listed On Birth Certificate)
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Consent To Change Of Name (Consent Of Parent Originally Listed On Birth Certificate) Form. This is a Maryland form and can be use in Circuit Court Statewide.
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Tags: Consent To Change Of Name (Consent Of Parent Originally Listed On Birth Certificate), DR-64, Maryland Statewide, Circuit Court
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IN THE MATTER OF:
Calendar No.
:
Plaintiff(s)
Index No.
JUDICIAL SUBPOENA
*
IN THE :
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CIRCUIT COURT
:
*
-against-
FOR
(child’s current name)
FOR CHANGE OF NAME TO:
:
*
Defendant(s)
:
......................................................
(child’s new name)
*
BY AND THROUGH HIS/HER
MOTHER/FATHER/GUARDIAN:
*
THE PEOPLE OF THE STATE OF NEW YORK
Civil No.:
*
(petitioner’s name)
TO
*
*
*
*
*
*
*
*
*
*
*
*
*
CONSENT TO CHANGE OF NAME
(Consent of Person Originally Listed on Birth Certificate)
GREETINGS:
(DOM REL 64)
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
1. Name, Age and Competence.
,
the Honorable
at the
Court
. My date of birth is
located at
County ofMy name is
inand I am capableon the
room
, of understanding what this consent means.
day of
, 20
, at
o'clock in the
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.
I believe that I am NOT the father of
,
(current name of child)
Your failure to comply with this subpoena is punishablelisted as the father on and will make you liable to
born on
,
, although I am as a contempt of court his/her
the party on whose(date of birth) subpoena was issued for a maximum penalty of $50 and all damages sustained as a
behalf this
result of your of Live Birth.
Certificate failure to comply.
Witness,
, one of the Justices of the
3. Consent. Honorable
Court in I hereby consent to having the child’s name 20
County,
day of
, changed. I hereby join in the foregoing
Petition and waive notice of process. I acknowledge that I have the right to revoke my consent at
any time prior to when an order changing the child’s name is entered. I acknowledge that I was
provided the opportunity to consult with legal counsel, if (Attorney mustbefore signing this Consent.
I so chose, sign above and type name below)
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.
Attorney(s) for
(date)
(your signature)
(your name - PRINTED)
Office
and P.O. Address
(street address)
(city , state , zip code)
Telephone No.:
No.:
E-Mail Address:
NOTE: Changing a child’s name will not change an existing child support obligation.
Mobile Tel. No.:
(telephone number)
Facsimile
Page 1 of 1
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DR 64 - Revised 13 Feb 2001
