CV-455, 05/19 Petition for Name Change for Minor Child under 14 247247301.47 and 786.36, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materials Page 1 of 2 Enter the name of the county in which this case was filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter the name of the minor child whose name is proposed to be changed in this Petition. Enter Petitioner and Co - Petitioner (if any) name (s) . You are the Petitioner (s) . IN THE MATTER OF T HE N AME CHANGE OF First Name Middle Name Last Nam e By : (Petitioner ) First Name Middle Name( s) Last Name By: ( Co - Petitioner ) First Name Middle Name(s) Last Name The clerk will enter the case number . Amended Petition f or Name Change for Minor Child under 14 (30708) Case No. In 1, check a, b, c or d. The p etitioner(s) state ( s ) : 1. The P etition is brought by a. b oth living parents, the sole surviving parent, or the sole adoptive parent of the minor child. b. o ne of the parents of the minor child who has two living parents and paternity has been established. c. t he mother, and the minor child is a non - marital minor child who is not adopted or w hose parents have not married, and paternity of the minor child has not been established. d. t he legal guardian/custodian of the minor child because either both parents are de ad or the pare ntal rights of both parents has been terminated by judicial proceedings. and co - address and the county in which the minor child lives. 2. [County, Street Address, City, State and Zip] Co - (if any) address is [County, Street Address, City, State and Zip] The minor child lives in County, Wisconsin. The minor child address is . In 3, enter the date and state of birth of the minor child. 3. The minor child was born on [Date] in the state of . In 4, enter the name on certificate. 4. The name that appears on the minor child [First Name] [Middle Name] [Last Name] In 5, enter the state that certificate was issued. 5. The birth certificate was issued in the state of . In 6, check the appropriate box. 6. The minor child is is not a sex offender required to register under 247301.45 , Wis. Stat s ., or a similar law of any other state. In 7, enter the proposed new name of the minor child. Enter the reason(s) for the change. 7. I /we [First Name] [Middle Name] [Last Name] For the following reason(s): American LegalNet, Inc. www.FormsWorkFlow.com CV-455, 05/19 Petition for Name Change for Minor Child under 14 247247301.45 and 786.36, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materials. Page 2 of 2 Check 8, if you want the name changed on the certificate. 8. I declare under the penalty of false swearing that the information I have provided is true and accurate. Petitioner Signature Print or Type Name Date I declare under the penalty of false swearing that the information I have provided is true and accurate. Co - Petitioner Signature Print or Type Name Date American LegalNet, Inc. www.FormsWorkFlow.com