IN THE CHANCERY COURT OF TENNESSEE FOR THE THIRTIETH JUDICIAL DISTRICT AT MEMPHIS IN THE MATTER OF: ______________________________________ A Minor by No: CH-__________________ ______________________________________ ______________________________________ Natural Mother or Father and Next Friend, Petitioner(s) PETITION TO CHANGE NAME OF MINOR TO THE HONORABLE CHANCELLORS OF THE CHANCERY COURT OF SHELBY COUNTY, TENNESSEE: Comes now your Petitioner(s) ______________________________________________________, natural Mother or Father and next of friend of__________________________________________, a minor in the above captioned cause, and files this petition requesting a name change and for cause of action would show unto the Court the following: 1. The Minor child is a resident, citizen of Shelby County, Tennessee. 2. The Natural Mother or Father and next friend is/are residents of Shelby County, Tennessee. 3. Petitioners would further show unto the Court that said minor child was born in ___________________________County, State of _________________________________ on _____________________________, _________________ and whose name appears as ____________________________________________________ on his/her birth certificate. 4. Petitioner desires to change the name of the minor for the following reasons: _________________________________________________________________________ _________________________________________________________________________. 5. Petitioner respectfully requests of this Honorable Court that he/she be allowed to change the minor’s name to ___________________________________________________________. American LegalNet, Inc. www.FormsWorkFlow.com 6. Petitioners further state that they are not a felon or criminal and that the reasons for the name change are personal and that they do not seek to change the minor’s name to avoid or evade any debts or obligations; nor is the requested name change for any illegal purpose. WHEREFORE, PREMISES CONSIDERED, YOUR PETITIONER PRAYS: 1. That upon the hearing of this cause, the court orders the legal change of the name of the minor child to ____________________________________________________. 2. For all other relief, both general and special, to which they may be entitled in the premises. _____________________________________ _____________________________________ Natural Mother or Father and Next friend of _____________________________________ a minor STATE OF TENNESSEE COUNTY OF SHELBY I, ___________________________and_____________________________, being first duly sworn according to law, state that the contents herein are true to the best of my knowledge, information and belief. ___________________________________________ ___________________________________________ Natural Mother or Father and Next friend of ______________________________________ a Minor Sworn to and subscribed before me this _________ day of _____________________, __________. Donna L. Russell, Clerk & Master Revised 01/23/07 By___________________________________ Deputy Clerk & Master American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT FOR NAME CHANGE OF MINOR BY NATURAL MOTHER OR FATHER AND NEXT FRIEND The undersigned, having petitioned for a name change, hereby makes oath, as required by T. C. A. § 29-8-101 (b) that: 1. I/we have never been convicted of First or Second Degree Murder. 2. I/we have never been convicted of any offense, the commission of which requires registration pursuant to the “Sexual Offender Registration and Monitoring Act” found in Tennessee Code Annotated, Title 40, Chapter 39. _______________________________ Relationship to Minor ___________________ ________________________________ Name(s) ________________________________ Address _______________________________ City, State, Zip Code _______________________________ Phone Number Sworn to and subscribed before me this _________ day of ___________________, ____________. Donna L. Russell, Clerk & Master By__________________________________ Deputy Clerk & Master Revised 01/23/07 American LegalNet, Inc. www.FormsWorkFlow.com IN THE CHANCERY COURT OF TENNESSEE FOR THE THIRTIETH JUDICIAL DISTRICT AT MEMPHIS IN THE MATTER OF: ________________________________________ A Minor by NO: CH-______________________ _______________________________________ _______________________________________ Natural Mother or Father and Next Friend, Petitioner(s) ORDER ALLOWING NAME CHANGE OF MINOR This cause came to be heard on this date upon the sworn petition of _________________________________________________, Mother or Father and Next Friend of _________________________________ a minor, upon their respective testimony in open court, and upon the entire record in this cause. It appearing to the Court from all of the above that said minor was born in _____________ ____________________________ on ____________________, ________ and is presently a resident of Shelby County, Tennessee and that petitioner for good and sufficient cause desires to change his/her name to ___________________________________________________ and that the change should be officially noted on the petitioner’s birth certificate, and the old information blocked and deleted. IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that the name of _________________________________ be and hereby changed to _________________________ _________________________________ and that such name change be officially shown and designated hereafter for all legal purposes as such and that a copy of this Order be furnished to appropriate State and County agencies to effectuate the purpose of this Order for Name Change. American LegalNet, Inc. www.FormsWorkFlow.com IT IS FURTHER ORDERED, ADJUDGED AND DECREED that the appropriate State and County agencies officially note on the Petitioner’s birth certificate the ordered changes and the old information blocked and deleted. ________________________________ CHANCELLOR _______________________________ DATE ______________________________ ______________________________ PETITIONER (S) Address: ______________________________ ______________________________ ______________________________ ______________________________ Phone number Revised 09/18/07 American LegalNet, Inc. www.FormsWorkFlow.com HOW TO OBTAIN NEW IDENTIFICATION FOR A MINOR TO GET A NEW BIRTH CERTIFICATE: Contact the Department of Health in the State where you were born. If you were born in TennesseeA certified copy of the court order; original birth certificate and a check or money order for $27.00 should be sent to: TN Vital Records, Central Services Bldg., 5th Avenue North, 1st Floor, Nashville, TN 37247 It usually takes 3-4 weeks to receive your new birth certificate. If you wish to speak with someone, call (615) 741-1763 Amendment Unit. TO GET A NEW SOCIAL SECURITY CARD: Go to any local Social Security office Call (800) 772-1213 to request an application, you should receive it in the mail within 2 weeks. The web address is www.socialsecurity.gov. There is no charge for a new social security card. TO GET A NEW DRIVERS LICENSE: Take a certified copy of the court order to the testing center located at 6340 Summer Ave. The hours of operation are Monday-Friday 8:30 a.m. - 5:00 p.m. There is a $12.50 charge for this service. If you wish to speak directly with someone about this issue, call 543-7920. The web address is www.state.tn.us/safety. Revised 01/23/07 American LegalNet, Inc. www.FormsWorkFlow.com