retype this form. The information in each paragraph needs to be changed as necessary for your particular case. This form is NOT intended to be legal advice and should NOT be relied upon as such. You are encouraged to consult Virginia Code §8.01-217. * * * V I R G I N I A: IN THE CIRCUIT COURT OF PRINCE WILLIAM COUNTY IN RE: NAME CHANGE FROM: _____________________ (Current name) TO: _____________________ (New name) ) ) ) ) ) ) ) CL No. _________________ PETITION FOR NAME CHANGE COMES NOW your Petitioner, ___________________________ (current name), and after being duly sworn, state under oath in support of [his/her] (choose only ONE) Petition to change [his/her] (choose only ONE) name to ____________________ (new name), and as grounds therefore respectfully represents as follows: 1. That the name the Petitioner’s father is _______________________, and the name of the Petitioner’s mother is _____________________________, and the maiden name of the Petitioner’s mother is ____________________________. 2. That the Petitioner was born on the ____ day of _____________, 19___, in the city and state of ________________________. 3. That the Petitioner resides at _________________ (current address). 4(a). That the Petitioner has no felony conviction record. American LegalNet, Inc. www.FormsWorkflow.com 4(b). That the Petitioner has been convicted of the following felony charges: (list all felony convictions). (Choose either # 4(a) OR #4(b) – NOT BOTH. Renumber as #4). 5(a). That the Petitioner is not presently incarcerated or on probation in any 5(b). That the Petitioner is presently on probation with the ________________ court. (name of court which ordered probation) Court. 5(c). That the Petitioner is presently incarcerated with the _______________ (name of court where Petitioner is incarcerated) Court. (Choose only ONE: # 5(a), OR #5(b) AND/OR #5(c). Renumber as #5.). 6(a). That the Petitioner has not previously changed [his/her] (choose only ONE) name before. 6(b). Petitioner has previously changed [his/her] (choose only ONE) name to ________________ (name changed to as a result of the marriage) as a result of marriage to _________________ (name of person you were/are married to). 6(c). Petitioner has previously changed [his/her] (choose only ONE) name from _______________ (list any names you have asked the Court to change in the past). (Choose either # 6(a) OR #6(b) AND/OR #6(c). Renumber as #6) 7. Petitioner does not ask to change [his/her] (choose only ONE) name for any illegal or fraudulent purpose, or to infringe upon the rights of others, but because ________________________________________________________________________ __________________________ (state why you are asking to your name). American LegalNet, Inc. www.FormsWorkflow.com WHEREFORE, your Petitioner prays that [his/her] (choose only ONE) name __________________ (current name) be changed to __________________ (new name). I ASK FOR THIS: ___________________________ (Signature) Typed name of Petitioner Type your complete address Type your phone number STATE OF VIRGINIA, COUNTY OF PRINCE WILLIAM, to wit: I ____________________________________, a Notary Public/Deputy Clerk in and for the County of _____________________________, Virginia, do hereby certify that on the _____ day of ____________________, 20_____, _______________________________ personally appeared before me and subscribed and swore to the foregoing statement as being true and accurate to the best of his/her knowledge and belief. Given under my hand this _____ day of ____________________, 20____. My commission expires _________________________________, 20____. ___________________________________ Notary Public/Deputy Clerk American LegalNet, Inc. www.FormsWorkflow.com