CAUSE NO. _________________ [Fill out cause number and heading information EXACTLY as it is written on the Petition.] IN THE MATTER OF THE § § § § § § CHANGE OF NAME OF [PRINT current, full, first, middle and last names] IN THE DISTRICT COURT OF TRAVIS COUNTY, TEXAS ___________ JUDICIAL DISTRICT [To be filled in by District Clerk’s Office] ORDER GRANTING CHANGE OF NAME OF ADULT On this day, this Court heard the Original Petition for Change of Name of Adult of _________________________________________________________, Petitioner. [Print your CURRENT name (full, first, middle and last names). YOU ARE THE PETITIONER.] Petitioner appeared in person and announced ready. The Court finds that it has jurisdiction of the case and of Petitioner. [The Court Will Select One of the Following] Testimony was not recorded, and the Court agreed that it did not need to be recorded. OR Testimony was recorded by the official court reporter for the Court. The Court finds the following information regarding the Petitioner: 1. Current full name: ___________________________________________________________. [PRINT your current, full, first, middle and last names.] 2. Date of birth: ___________________________________. [Month, Day, Year] 3. Place of birth: _______________________________________________________________. [City, County, State, Country] 4. Home address: _______________________________________________________________. [Street Address (No PO Boxes), City, State, Zip Code] 5. Social Security Number: ________________________. 6. Driver’s license number ____________________ and state of issuance: __________________. 7. [Check One] The Petitioner is: male. female. 8. Petitioner’s race is: ________________________________. 9. [Check one of the Following:] Petitioner does not have a SID (State Identification) or FBI (Federal Bureau of Investigations) number. OR Petitioner’s SID number: __________________. Petitioner’s FBI number: ___________________. Pro Se Order Granting Change Name of Adult, approved 8/28/03, page 1 of 2 American LegalNet, Inc. www.USCourtForms.com 10. [Check One of the Following:] Petitioner has not been charged with a crime above the grade of Class C misdemeanor. OR Petitioner has been charged with these crimes above the grade of Class C misdemeanor. Listed below are the cause number and the court for each crime in which a warrant was issued for Petitioner’s arrest or in which charges were filed or presented against Petitioner: _________________________________________ __________________ _________________ [Offense] [Case Number] [Court Number] _________________________________________ __________________ _________________ [Offense] [Case Number] [Court Number] _________________________________________ __________________ _________________ [Offense] [Case Number] [Court Number] _________________________________________ __________________ _________________ [Offense] [Case Number] [Court Number] _________________________________________ __________________ _________________ [Offense] [Case Number] [Court Number] 11. Check one of the Following: Petitioner has not had a final conviction of a felony. OR Petitioner has had a final conviction of a felony, but Petitioner received a certificate of discharge by the pardons and paroles division of TDCJ at least two years ago; or Petitioner completed a court ordered period of probation, and it has been at least two years since the probationary period was completed, as required by section 45.103(b) of the Texas Family Code. 12. Check one of the Following: Petitioner is not required to register as a sex offender under Chapter 62 of the Texas Code of Criminal Procedure. OR Petitioner is required to register as a sex offender under Chapter 62 of the Texas Code of Criminal Procedure. Petitioner has notified the appropriate law enforcement authority of Petitioner’s proposed name change. Petitioner has submitted proof of the notification to this court. 13. Petitioner attached a legible and complete copy of Petitioner’s fingerprints on a Department of Public Safety or Federal Bureau of Investigation fingerprint card to the petition. 14. Petitioner’s change of name is in Petitioner’s interest or benefit and is in the interest of the public. IT IS, THEREFORE, ORDERED that Petitioner’s name is changed from: to [Print CURRENT, full, first, middle and last names.] [Print ENTIRE NEW full name.] IT IS FURTHER ORDERED that all relief requested in this case not expressly granted is denied. SIGNED on ____________________ by PRESIDING JUDGE _____________________________. Pro Se Order Granting Change Name of Adult, approved 8/28/03, page 2 of 2 American LegalNet, Inc. www.USCourtForms.com