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Change of Name of Adult Petition

State of _______________ County of ________________

Court _____________________________ Docket No. ________________________

Name of Petitioner(s):

In re: Change of Name of Adult

________________________________ First

Middle

From: _______________________________

Last

Previous Legal Name

To: _________________________________ New Legal Name

Petitioner(s) makes (make) the following declaration: I. Petitioner’s Birth Name: The petitioner’s name at birth was ______________________________________________________________ First

Middle

Last

and until the date of this petition, the petitioner has always been referred to as this name or:
 _____________________________________________________________________ List Name(s) Petitioner has been known as (if any)

II. Birth Date and Place: The petitioner was born on _____________________, Date

In the City of _____________________, County of _______________________, City

State of _______________________. State

County


III. Petitioner’s Residency: The petitioner’s official legal address is ________________________________________________________________ Street Address

City of ________________, County of _________________, State of _________ City

County

State

and has resided at this address for approximately _______ years. IV. New Name & Reason for Name Change: Petitioner seeks to change name to ________________________________________________________________ Petitioner’s New Legal Name

for the following reason(s): ________________________________________________________________ V. Outstanding Judgments: The Petitioner does not have any outstanding judgments, has never been convicted of a crime, and is not involved in any pending legal actions. VI. Additional Declarations: In addition to the foregoing statements, the Petitioner(s) further declares ________________________________________________________________ Additional Declarations (if any) NOW, THEREFORE, the Petitioner(s) requests (request) that the court order the Petitioner's name changed as follows:

From: ____________________________________________ Previous Legal Name

To: ______________________________________________ New Legal Name


Verification (Petitioner) I,_______________________________________________________________ Petitioner Legal Name

affirm under penalty of perjury that I am the Petitioner in the foregoing Petition to Change Name of Adult and that all statements in this Petition are accurate to the best of my knowledge. 
 _________________________________________                    _______________________________   Signature  of  Petitioner  #1                                                                                      Date     Notary Acknowledgement   State of ___________ County of ______________________________ Subscribed, Sworn and acknowledged before me by ______________________________, the Principal, and subscribed and sworn to before me by ______________________, witness, this ______________________ day of ________________________. ______________________________ Notary Signature Notary Public In and for the County of ______________________________ State of ______________________________ My commission expires: ______________________________

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North Dakota Name Change Petition