CV-450, 05/19 Petition for Name Change for Adult or Minor 14 or Older 247247301.45 and 786.36, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materials Enter the name of the county in which this case was filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter your current name. You are the Petitioner . IN THE MATTER OF T HE NAME CHANGE OF First Name Middle Name Last Name The clerk will enter the case number . Amended P etition f or Name Change f or Adult or Minor 14 or Older ( 30708 ) Case No. In 1, enter your complete address. In 2, enter the County where you live. I am the Petition er and state: 1. My address is [Street Address, City, State and Zip ] . 2. I live in County, Wisconsin . In 3, enter the date and state of your birth. 3 . I was born on [Date] in the s tate of . In 4, enter the state that the birth certificate was issued. 4. My birth certifi cate was issued in the state of . In 5 , enter name as it appears on the birth certificate. 5. T he name that appears on my birth certificate is [First Name] [Middle Name] [Last Name] In 6 , enter your job title . 6 . My current job is . In 7 , check a or b. In 8 , check the appropriate box . 7 . A . I do not work in a job for which a license has been required by any state, or my only professional license is to teach in the public schools in this state. B . I do work in a job (other than a licensed teacher in Wisconsin public schools) for which a license has been required by any state. However, I have notified the state board or commission for my profession and they do not object to my proposed name change. 8 . I am am not a convicted sex offender required to register under 247247301.45, 938.34 (15m), and 938.345(3), Wis . Stat s ., or a s imilar law of any other state. In 9 , enter your proposed new name . Enter the reason(s) you want to change your name. Check 10, if you want your name changed on your WI birth and/or marriage certificate. 9. I wish to change my name to [ First Name] [Middle Name] [Last Name] For the following reason(s): 10. I wish to change the name on my Wisconsin birth marriage certificate. I declare under the penalty of false swearing that the information I have provided is true and accurate. Signature Print or Type Name P hone Number Date American LegalNet, Inc. www.FormsWorkFlow.com