Minor Child Name Change Petition Form

Petitioner Information

Petitioner Full Name Relationship to Minor Address Phone Number Email Address

Minor Information

Current Full Name of Minor Date of Birth Place of Birth Current Address Proposed New Name

Parental Information

Father’s Name Mother’s Name Do all parents/guardians consent to this change? Yes No

Reason for Name Change

Please state the reason for the requested name change

Additional Information

Are there any pending legal matters involving the minor?

Declaration

I declare that the information provided is true and correct.