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Petition For Individual Minors 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 Individual Minors Change Of Name, CIV-GP-82M, 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
INDIVIDUAL MINORS
CHANGE OF NAME
As Parent and Natural Guardian for leave
to Change Minor's Name To
I.
, by this petition, alleges
2.
I am the
of a Minor
3.
The Minor's present name is
4.
The name which I propose that the Minor will assume in place and stead of the Minor's present name is:
5.
The Minor's Age, Date of Birth and Place of Birth are: Age:
Date of Birth:
Place of Birth:
Note: If the Minor was horn in the State of New York you must attach either: a) a Birth Certificate, h) a
Certified Transcript of such Birth Certificate, or c) a Certificate from the Commissioner or the local Board of
Health that no such Certificate is available.
6.
The Minor's present residence is:
7.
For each of the following four questions, place your initials in the appropriate column.
YES
NO
a) Has the Minor ever been convicted of a crime?
b) Has the Minor ever been adjudicated a bankrupt?
c) Are there judgments or liens of record against the Minor?
d) Are there any actions or proceedings pending to which the Minor is a party?..
If your answer is ''YES'' to any of the four questions above, give particulars below in sufficient detail to
readily identify the matter referred to:
(If additional space is required, attach (a) separate sheet(s) of paper with the details.)
CIV-GP-82M Page 2 (Revised October, 2003)
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PETITION FOR INDIVIDUAL MINOR'S CHANGE OF NAME - PAGE 2
6.
I have/have not made a previous application to change the Minor's name in this or any other Court.
(Strike out one)
(If you have, give details and reason for this current application below.)
7.
The reasons for this application are as follows:
8.
WHEREFORE, your Petitioner respectfully requests that an Order be granted permitting this change of
name.
Date
Signature of Petitioner
VERIFICATION
State of New York, County of
ss.:
, being duly sworn, deposes and says:
s/he is the petitioner named above, that petitioner has read the petition and knows the truth of the contents thereof
except for those matters alleged to be on information and belief, and as to those matters, petitioner believes them to
be true.
Signature of Petitioner
Sworn to before me this
day of
20
Signature of Notary Public
CIV-GP-82M Page 2 (Revised October, 2003)
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