CAUSE NO. ______________ [To be filled in by District Clerk’s Office] 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] ORIGINAL PETITION FOR CHANGE OF NAME OF ADULT TO THE HONORABLE JUDGE OF THIS COURT: I, _____________________________________, Petitioner, an adult, bring this suit for change of name. [PRINT your CURRENT name (full, first, middle and last names). YOU ARE THE PETITIONER.] In support of this request, I provide the following information about myself: 1. No discovery is intended. 2. My current full name is ____________________________________________________________. [Print your CURRENT name (full, first, middle and last names).] 3. My date of birth is ___________________________________. [Month, Day, Year] 4. I was born in ____________________________________________________________________. [City, County, State, Country] 5. My home address is _______________________________________________________________. [Street Address (No PO Boxes) City, State, Zip Code] 6. My Social Security Number is _______________________. 7. My Driver’s License number is ______________ and it was issued in the state of ______________. 8. Check One: I am male. female. 9. My race is __________________________. 10. I request that my name be changed to __________________________________________________. [PRINT and FULLY spell the first, middle and last name you want.] 11. The reason I want to change my name is: Pro Se Original Petition for Change of Name, approved 8/28/03, page 1 of 3 American LegalNet, Inc. www.USCourtForms.com 12. Check ONE of the Following: I do not have a SID (State Identification) or FBI (Federal Bureau of Investigations) number. OR My SID number is _____________________ and my FBI number is ________________________. 13. Select ONE of the Following: I have not been charged with a crime above the grade of Class C misdemeanor. OR I have 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 my arrest or in which charges were filed or presented against me: _________________________________________ __________________ _____________________ [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] 14. Check ONE of the Following: I have not had a final conviction of a felony. OR I have had a final felony conviction, but I received a certificate of discharge by the pardons and paroles division of TDCJ at least two years ago; or I completed a court ordered period of probation, and it has been at least two years since I completed my probation, as required by section 45.103(b) of the Texas Family Code. 15. Check ONE of the Following: I am not required to register as a sex offender, under Chapter 62 of the Texas Code of Criminal Procedure. OR I am required to register as a sex offender, under Chapter 62 of the Texas Code of Criminal Procedure. I have notified the appropriate local law enforcement authority of my proposed name change and I have attached proof of the notification with this petition as Exhibit ‘B’. Pro Se Original Petition for Change of Name, approved 8/28/03, page 2 of 3 American LegalNet, Inc. www.USCourtForms.com 16. I have attached a legible and complete set of my fingerprints on a Department of Public Safety or Federal Bureau of Investigation fingerprint card to this petition as Exhibit ‘A’ as required by Texas Family Code section 45.102. 17. I respectfully ask that the Court issue an order changing my name to: [Fully spell ENTIRE NEW name.] and ask that the Court grant me any other relief to which I am entitled, general or specific, legal or equitable. RESPECTFULLY SUBMITTED: [Your CURRENT Full Name] [Home Address, NO PO Boxes] [Area Code, Telephone Number] I, ________________________________________, Petitioner, swear under oath that the facts stated in [Print your CURRENT Full Name] the above Original Petition for Change of Name of Adult are true and correct. [Signature, using CURRENT full first, middle, and last names] [DO NOT SIGN UNTIL YOU ARE IN FRONT OF THE NOTARY] TO BE COMPLETED BY NOTARY: SIGNED under oath before me on __________________. __________________________________ Notary Public in and for the State of Texas Notes to Petitioner: Remember to attach a legible and complete set of your fingerprints on a Texas Department of Public Safety or Federal Bureau of Investigation fingerprint card to this petition as Exhibit ‘A’ as required by Texas Family Code section 45.102. Registered sex offenders must attach proof that they have notified the law enforcement agency with which they are registered that they are requesting a name change. Fingerprint cards and notary services are located at the Information Booth on the first floor of the Courthouse. File name change petitions in the District Clerk’s Office, room 308 of the Courthouse. There is a filing fee. Pro Se Original Petition for Change of Name, approved 8/28/03, page 3 of 3 American LegalNet, Inc. www.USCourtForms.com