IN THE CIRCUIT COURT OF TENNESSEE FOR THE THIRTIETH JUDICIAL DISCTRICT AT MEMPHIS IN THE MATTER OF: Docket Number PETITIONER [First, Middle, Last Name(s)], PETITION FOR CHANGE OF NAME TO THE HONORABLE JUDGES OF THE CIRCUIT COURT OF SHELBY COUNTY, TENNESSEE: Comes now your Petitioner , in the above styled and numbered cause, and files this Petition requesting change of name and for cause of action would show unto the Court the following facts, to-wit: 1. That your petitioner is an adult resident, citizen of , Shelby County, Tennessee. 2. Your Petitioner would further show unto the Court that he/she was born in County, on and whose name appears as on his/her birth certificate. 3. That your petitioner respectfully requests of this Honorable Court that he/she be able to change their name to 4. . Your Petitioner herein states that he/she is not a felon or criminal and that the reasons for the name change are personal and that he/she does not seek to change their name in order to avoid or evade any debts or obligations as he/she is not indebted to anyone in any significant amount, and that they do not request this change of name for any illegal purpose. American LegalNet, Inc. www.FormsWorkFlow.com WHEREFORE, PREMISES CONSIDERED, YOUR PETITIONER PRAYS: 1. That upon the hearing of this cause, the Court order the legal change of the name of the Petitioner to 2. . For all other relief, both general and special, to which they may be entitled in the premises. _________________________________________ PETITIONER (Signature) STATE OF TENNESSEE COUNTY OF SHELBY I, , being first duly sworn according to law, state that the contents herein are true to the best of my knowledge, information, and belief. _________________________________________ PETITIONER (Signature) Sworn to and subscribed before me this ___________ day of _________________________, 20_____. _________________________________________ Notary/Deputy Clerk My Commission Expires: _________________________ American LegalNet, Inc. www.FormsWorkFlow.com STATE OF TENNESSEE COUNTY OF SHELBY AFFIDAVIT FOR NAME CHANGE The undersigned, having petitioned to change his/her name, hereby makes oath, as required by T.C.A. § 29-8-101 (b) that: 1. I have never been convicted of First or Second Degree Murder. 2. I have never been convicted of any offense which requires a sexual offender to register pursuant to the "Sexual Offender Registration and Monitoring Act" found in Tennessee Code Annotated, Title 40, Chapter 39. _____________________________________ PETITIONER (Signature) Sworn to and subscribed before me this _________ day of _________________________, 20_____. _____________________________________ Notary/Deputy Clerk My Commission Expires: ________________________ American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT OF TENNESSEE FOR THE THIRTIETH JUDICIAL DISCTRICT AT MEMPHIS IN THE MATTER OF: Docket Number PETITIONER [First, Middle, Last Name(s)], ORDER ALLOWING NAME CHANGE This cause came to be heard on this date upon the sworn Petition of 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 was born in on (City and State) presently a resident of and is (Date of Birth) , 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. IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that the name of be and hereby changed to and that their name 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. __________________________________ PETITIONER (Signature) __________________________________ JUDGE __________________________________ DATE American LegalNet, Inc. www.FormsWorkFlow.com