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| County Clerk, County | Index Number: |
| Application for INDEX NUMBER |
| Pursuant to CPLR 306-a | (Do Not Write Here) |
FEE $210.00
TITLE OF ACTION OR PROCEEDING
Supreme Court, County
Legal Name Change of
Petitioner:
, New York,
Indexed and Entered
(Do not write on line above.)
DO NOT DETACH
INDEX NUMBER
FEE $ 210.00
Supreme Court, County
COMPLETE
| THIS STUB | Legal Name Change of |
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF
______________________________________________
IN THE MATTER OF THE APPLICATION OF
| , | PETITION FOR A |
| PETITIONER, | NAME CHANGE |
| FOR LEAVE TO CHANGE HIS/HER NAME TO: | Index #__________ |
______________________________________________
TO THE SUPREME COURT OF THE STATE OF NEW YORK:
The Petition of respectfully shows this court:
| 1. | The petitioner resides at , in the city of , County of , and has so resided for a period of years and months prior to the making of this application. |
| 2. | The petitioner, , was born at , in , United States on and is now years of age. (Attached hereto and made a part hereof is a copy of the petitioner's birth certificate.)
and has been married previously.and has been married previously.
WHEREFORE, petitioner respectfully prays for an order permitting the petitioner to assume the name in place of that of
DATED: ______________________, 20___.
___________________________________
____________________________________________________________________________________
THIS IS TO CERTIFY that I, _____________________________ being duly sworn deposes and says: your deponent is the Petitioner in the within action; your deponent has read the foregoing Petition and knows the contents thereof. The same is true to deponents own knowledge, except as to the matters therein stated to be alleged on information and belief, and as to those matters deponent believes it to be true.
Sworn to before me this _____ day of ____________, 20___. ____________________________________ Petitioner
_____________________________ Notary Public
SUPPLEMENTAL STATEMENT TO PETITION FOR A NAME CHANGE FOR
Criminal Convictions
Family Support Obligation
____________________________________________________________________________________
THIS IS TO CERTIFY that I, _____________________________ being duly sworn deposes and says: your deponent is the Petitioner in the within action; your deponent has read the foregoing Statement and knows the contents thereof. The same is true to deponents own knowledge, except as to the matters therein stated to be alleged on information and belief, and as to those matters deponent believes it to be true.
Sworn to before me this
_____ day of ____________, 20___. ____________________________________ Petitioner
_____________________________ Notary Public
At a _______Term, Part __ of the ______ Court of the State of New York, held in and for the County Of __________, ______________, _____________, New York on the ________day of ________, 20___.
PRESENT: HON. _______________________________
IN THE MATTER OF THE APPLICATION OF
NAME CHANGE ORDER
Upon reading and filing the petition of verified the ______ day of _________, 20___ praying for leave to change his name/her name to and the court being satisfied thereby that petition is true and that there is no reasonable objection to the change of name proposed.
Now on motion of , Petitioner, it is
ORDERED that the petitioner, , having been born in the City of , County of , United States, Birth certificate #
ORDERED that this order shall be entered and the papers upon which it was granted shall be filed, prior to the publication hereinafter directed, in the office of the Clerk of the County of , wherein petitioner resides, and it is further
Notice is hereby given that an order entered by the Supreme Court County, on the _____ day of ________, 20__, bearing Index No. ____________, a copy of which may be examined at the office of the clerk, located at ________________, _______________, N.Y. grants me the right, to assume the name . My present address is , , New York ; My date of birth is ; My present name is ; and it is further
ORDERED that proof of publication as heretofore directed shall be filed in the office of the County Clerk within 90 days after the signing of this order, and it is further
ORDERED that upon full compliance with the provisions of this order, petitioner shall be known by the name which he/she is authorized to assume, and by no other name.
ENTER
___________________________________ J.S.C.
LETTER TO NEWSPAPER
DATE:
Newspaper , New York
Dear Sir or Madam:
Re: Name Change Notice of
Please print the following Notice in your newspaper one time. After publication has been completed, please send the Certificate of Publication to me in the enclosed self addressed stamped envelope.
Notice is hereby given that an order entered by the Supreme Court, county, on the ___ day of ___, bearing Index Number __________, a copy of which may be examined at the office of the clerk, located at_____________________________,_____________, NY _______, in room number ____, grants me the right to assume the name of , the date of my birth is , the place of my birth is , , my present name is .
Please bill me for the cost of publication. If you have any questions, please feel free to contact me.
I thank you for your cooperation.
Sincerely, , New York, |
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When a name change is part of a marriage, divorce, adoption or citizenship, the request is processed as part of that case.
Changing your name in New York outside of a marriage, divorce, adoption or citizenship is a different process. To change your legal name, you must file a New York Name Change Petition and Order with the court. This petition must first be notarized and in some cases you may need to also provide a self-addressed and stamped envelope. When you file you will also need to provide the courts with a valid ID, a birth certificate or other form of proof of birth, proof of your current address, and any other paperwork that may prove that you meet the requirements of a name change in New York. If your petition meets all requirements and you are not changing your name to avoid legal trouble, your papers will be reviewed by the Court Clerk and submitted to a Judge. Once the judge reviews your petition to confirm you meet the requirements, they will grant or deny your name change request.
