New York Petition for Change of Name of Adult (with Order)

(Updated for 2019) Filing Requirements: In New York, to change one's name, the Petitioner, i.e., the person seeking to change his or her name, must file: (1) an original and copy of a Name Change Petition and Final Order, (2) a certified copy of the birth certificate (if the petitioner was born in New York), and (3) a self-addressed stamped envelope. (The Petitioner may wish to contact the court clerk in the county or borough in which the Petitioner resides to determine the filing fees and other local requirements. The index number for the petition is provided upon filing with the court and after paying the court's filing fee.) Basis for Name Change: Any lawful reason that the Petitioner deems a benefit is adequate to satisfy the requirements of state law. For example, the Petitioner may prefer a new name due to social or religious reasons. The Petitioner may not change his or her name for purposes of fraud or evasion, or if it will violate the rights of others. Statutory Requirements: New York Civil Rights Law §61 specifies numerous requirements that a valid name change petition must contain. The petition below complies with each of those requirements. The petition "shall specify the grounds of the application, the name, date of birth, place of birth, age and residence of the individual whose name is proposed to be changed and the name which he or she proposes to assume." The petition must also specify: "(a) whether or not the petitioner has been convicted of a crime or adjudicated a bankrupt; (b) whether or not there are any judgments or liens of record against the petitioner or actions or proceedings pending to which the petitioner is a party, and, if so, the petitioner shall give descriptive details in connection therewith sufficient to readily identify the matter referred to; (c) whether or not the petitioner is responsible for child support obligations; (d) whether or not the petitioner's child support obligations have been satisfied and are up to date; (e) the amount of a child support arrearage that currently is outstanding along with the identity of the court which issued the support order and the county child support collections unit; (f) whether or not the petitioner is responsible for spousal support obligations; (g) whether or not the petitioner's spousal support obligations have been satisfied and are up to date; and (h) the amount of spousal support arrearage that currently is outstanding along with the identity of the court which issued the support order." Purchase this document set to receive the petition, the order, and instructions, all of which are fully warranted compliant with New York law.

______________ Court of the State of New York County of ______________
In the Matter of the Application of: __________________________________________ Petitioner,	PETITION FOR A NAME CHANGE
For Leave to change his / her name to: __________________________________________ (Proposed New Name)	Index No. _____________

The Petition of ___________________________________ respectfully shows this court:

1.    The Petitioner resides at _____________________________________________ (Street Address), in the ___________ of __________________, County of __________________, and has resided at this address for a period of _______ years and _______ months prior to filing this Petition..

2.   The Petitioner,  ___________________________________, was born on _______________________ [date] and is now ______ years of age. (Attached to this Petition is a copy of the Petitioner's birth certificate, which is incorporated herein by reference.)

3.   The Petitioner proposes to change His / Her said name to ________________________________________________.

4.   The Petitioner is a natural born citizen of the United States of America.

5.   The Petitioner is / is not  married and has / has not  been married previously.

6.   The Petitioner: (Check One):

____    has never been convicted of a crime.

____    has been convicted of a crime, the details of which are attached in a separate statement, annexed hereto and made a part hereof.

7.   The Petitioner has never been adjudicated a bankrupt.

8.   The Petitioner affirms that there are no judgments or liens of record against the Petitioner or actions or proceedings pending to which the petitioner is a party. The Petitioner affirms that there are no voluntary or involuntary bankruptcy or insolvency proceedings pending against the Petitioner in any court or before any officer, person, body or board having jurisdiction thereof. The petitioner has not, at any time, made any assignments for the benefit of creditor. (If the previous statement does not accurately describe the Petitioner’s circumstances, enter the correct details instead of previous statement.)

9.   The Petitioner affirms that there are no claims, demands, liabilities or obligations of any kind whatsoever on a written instrument or otherwise against the Petitioner’s infants under the only names by which they have been known, which are the names sought herein to be abandoned, and Petitioner’s infants have no creditors who may be adversely affected or prejudiced in any way by the proposed change of name.  (If the previous statement does not accurately describe the Petitioner’s circumstances, enter the correct details instead of previous statement.)

10. The Petitioner affirms that: (Check Only One):

____    the Petitioner is not responsible for child support obligations.

____    the Petitioner is responsible for child support obligations. The Petitioner’s child support obligations have been satisfied and are up to date. The identity of the court which issued the support order is: _______________________________________________________________. The identity of the county child support collections unit is: _______________________________________________________________.

____    the Petitioner is responsible for child support obligations. The amount of child support arrearage that currently is outstanding is $_______________. The identity of the court which issued the support order is: _______________________________________________________________. The identity of the county child support collections unit is: _______________________________________________________________.

11. The Petitioner affirms that: (Check Only One):

____    the Petitioner is not responsible for spousal support obligations.

____    the Petitioner is responsible for spousal support obligations. The Petitioner’s spousal support obligations have been satisfied and are up to date. The identity of the court which issued the support order is: _______________________________________________________________.

____    the Petitioner is responsible for spousal support obligations. The amount of spousal support arrearage that currently is outstanding is $_______________. The identity of the court which issued the support order is: _______________________________________________________________.

12. The grounds of this application to change the Petitioner’s name are that the Petitioner desires the name change for social reasons.

13. No previous application has been made for the relief sought herein.

WHEREFORE, petitioner respectfully prays for an order permitting the petitioner to assume the name _______________________________________ [proposed new name] in place of that of _______________________________________ [current name].

DATED: ___________________, 20______.

_______________________________________
(Signature of petitioner)

INDIVIDUAL VERIFICATION

State of New York, County of ________________  ss.:

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 deponent’s 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______.

____________________________________
Notary Public

__________________________________
Petitioner