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Petition For Family Change Of Name Form. This is a New York form and can be use in New York Local County.
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Tags: Petition For Family Change Of Name, CIV-GP-82F, New York Local County, New York
Civil Court of the City of New York
County of
Index Number
In the Matter of the Application of
PETITION FOR
FAMILY
CHANGE OF NAME
for Leave to Change Their Name(s) To
(and
Primary Adult
), by this petition, allege(s)
(Second Adult, if any)
1.
The present family name is:
2.
The new name which we propose to assume in place and stead of the present name is:
3.
The individuals* whose names are included in this application are incorporated herewith are as follows:
Present Name
Proposed Name
Place of Birth
Date of Birth
Present
Age
*Primary Adult (and Secondary Adult, if any) and all minors under the age of 18 should he listed. Minors
between the ages of 14 and 18 must consent to this change by signing the Consent on page 2.
4.
Has any applicant been convicted of a crime, adjudicated a bankrupt, or are there any judgments or liens against any
applicant, or are there any actions or proceedings pending against any application, or does any applicant have any obligations
for child support and/or spousal support? NO
YES*
*If the answer to any part of this question is YES for any applicant, each applicant who answers YES must fill out a
CIV-GP-82F supplemental form.
5.
Our present residence is:
6.
The reasons for this application are as follows:
7.
WHEREFORE, your Petitioner(s) respectfully request(s) that an Order be granted permitting this requested
change of name.
Date
Signature of Petitioner
Signature of Second Adult
CIV-GP-82F Page 1 (Revised November, 2006)
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CONSENTS
I,
am 14 years of age or over, and less than 18 years of age,
and I have read the annexed petition for family change of name, and I consent to the same.
,
Signature
Date
I,
am 14 years of age or over, and less than 18 years of age,
and I have read the annexed petition for family change of name, and I consent to the same.
,
Date
Signature
I,
am 14 years of age or over, and less than 18 years of age,
and I have read the annexed petition for family change of name, and I consent to the same.
,
Date
Signature
I,
am 14 years of age or over, and less than 18 years of age,
and I have read the annexed petition for family change of name, and I consent to the same.
,
Date
Signature
VERIFICATION
State of New York County of
ss.:
, being duly sworn, deposes and say(s):
s/he/they is (are) the petitioner(s) named above, that s/he/they has/have read the petition and know(s) the truth of the
contents thereof except for those matters alleged to be on information and belief, and as to those matters, s/he/they
believe(s) them to be true, and that the signature(s) of the consenting party (parties) above is/are the true signature(s) of
the minor child(ren) who is/are included in the petition.
Signature of Petitioner
Sworn to before me this
day of
Signature of Notary Public
Signature of Second Adult
20
Sworn to before me this
day of
20
Signature of Notary Public
CIV-GP-82F Page 2 (Revised November, 2006)
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