IN THE MATTER OF: Your Current Name Street Address City, State, Zip Telephone * * * * IN THE CIRCUIT COURT FOR Civil No.: * * FOR CHANGE OF NAME TO: New Name * * * * * * * * * * * * * * * PETITION FOR CHANGE OF NAME (Adult) (DOM REL 60) TO THE HONORABLE, THE JUDGE OF SAID COURT: Petitioner, to this Court: 1. That I was born on Your Birthdate Your Current Name , respectfully represents , in Your Birthplace - City, State, County Present Address , and presently reside at 2. That I was born Your Birth Name . (See copy of attached birth certificate.) My name has been changed to the following since birth for the following reasons: (List any reasons why your name may have changed since birth, for example, marriage). Name Changed To: Reason: I have attached any documents that changed my name officially. Page 1 of 2 DR 60 (Rev. 9/2005) American LegalNet, Inc. www.FormsWorkFlow.com 3. Select one of the following: I have never registered as a sexual offender; OR I am or have previously been registered as a sexual offender under the following name: Full Name as Registered 4. I am requesting this change of name because: 5. . I wish to change my name to: New Name 6. I hereby certify that the above change of name is not requested for any illegal or fraudulent purposes. WHEREFORE, I respectfully request that the Court pass an Order changing my name from . Current Name New Name to I, , solemnly affirm under the penalties of Your Current Name perjury, that the contents of the foregoing paper are true to the best of my knowledge, information and belief. Date Your Signature Your Name - Printed Address City, State, Zip Telephone Page 2 of 2 DR 60 (Rev. 9/2005) American LegalNet, Inc. www.FormsWorkFlow.com