New York Petition for Change of Name of Minor

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About this Form:  In most jurisdictions, a Petition for Change of Name of Minor must be filed in the county court in which the minor child lives.  Any lawful reason that the Petitioner(s) deems (deem) a benefit is typically adequate to satisfy most courts.  For example, the Petitioner(s) may prefer a new name due to social or religious reasons.  The Petitioner(s) may not change the minor child's name for purposes of fraud or if it will violate the rights of others.  The Petitioner(s) should contact the court clerk in the county in which the minor child resides to determine the filing fees, docket number, and other local requirements.

 
Petition for Change of Name of Minor

State of New York
County of ________________
Court _____________________________
Docket No. ________________________


Name of Petitioner(s):
In re:  Change of Name of Minor  
_____________________________
_____________________________
From: _____________________________
To: _______________________________

Petitioner(s) makes (make) the following declaration:

1. Birth Date and Place:   The minor was born on _______________________, 20____ in  ________________________ [city],  ________________________ [county], ________________________ [state]. A certified copy of the minor's birth certificate is attached to this petition.

2. Birth Name:  The minor was named ____________________________________________ at birth, and as of the date of this petition, the minor has always been known by that name, with the following exceptions, if any:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
[list all legal names previously held].

3. Residence:  The minor resides at _____________________________________________________________________________ [insert the minor's residential address] and has lived at this address for ________ [insert length of time in months or years at this address].   The Petitioner(s) resides (reside) at _____________________________________________________________________________ [insert residential address] and has (have) lived at this address for ________ [insert length of time in months or years at this address].

4. Minor's Parents:  The father of the minor is named ______________________________________________, and he resides at _____________________________________________________________________________ [insert residential address of father].  The mother of the minor is named ______________________________________________, and she resides at _____________________________________________________________________________ [insert residential address of mother]. 

5. Reason for Name Change:  Petitioner(s) seeks (seek) to change said minor's name to ______________________________________________ and offers (offer) the following reason(s) for seeking to do so:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________.

6. Legal and Creditor Status:  The minor does not have any outstanding judgments, has never been convicted of a crime, and is not involved in any pending legal actions.

7. Additional Declarations:  In addition to the foregoing statements, the Petitioner(s) further declares (declare):
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
[insert additional declarations, if any].

NOW, THEREFORE, the Petitioner(s) requests (request) that the court order the minor's name changed as follows:

From: ____________________________________________
To: ______________________________________________


Verification (Petitioner #1)

I, _____________________________________________________________________________
_____________________________________________________________________________ [name of Petitioner], affirm under penalty of perjury that I am the (a) Petitioner in the foregoing Petition to Change Name of Minor and that all statements in this Petition are accurate to the best of my knowledge.
 

_____________________________________________
_________________
Petitioner's Signature
Date


_____________________________________________
Petitioner's Address, Line 1

_____________________________________________

Petitioner's Address, Line 2


Verification (Petitioner #2, if any)

I, _____________________________________________________________________________
_____________________________________________________________________________ [name of Petitioner], affirm under penalty of perjury that I am the (a) Petitioner in the foregoing Petition to Change Name of Minor and that all statements in this Petition are accurate to the best of my knowledge.
 

_____________________________________________
_________________
Petitioner's Signature
Date


_____________________________________________
Petitioner's Address, Line 1

_____________________________________________

Petitioner's Address, Line 2


Subscribed and sworn to before me on this ____ day of __________________, 20_____.
 
 
__________________________________
Notary

   - - - - Consent to Change of Name of Minor Form - - - -

(Note: The grey box below is not a part of the Petition and is included for informational purposes only. You should not include the grey box as part of this document.)
 
About this Consent to Change of Name of Minor Form:  The following consent form may accompany the Petition for Change of Name of Minor if needed. Contact the court clerk in the county in which the minor resides to determine whether this consent is required.


Consent to Change of Name of Minor

State of New York
County of ________________
Court _____________________________
Docket No. ________________________


Name of Petitioner(s):
In re:  Change of Name of Minor  
_____________________________
_____________________________
From: _____________________________
To: _______________________________


I make the following declaration:

1. Name:  My name is ____________________________________________, and as of the date of the signing of this Consent, I have always been known by that name, with the following exceptions, if any:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

2. Residence:  I reside at _____________________________________________________________________________ [insert the residential address] and have lived at this address for ________ [insert length of time in months or years at this address].

3. Consent to Change of Name of Minor:  I am fully informed of the legal consequences and effects, and I give my consent to the request of the Petitioner(s) to change the name of said minor child as follows:

From: ____________________________________________
To: ______________________________________________


Verification

I, _____________________________________________________________________________
_____________________________________________________________________________ [name of individual granting his or her consent], affirm under penalty of perjury that all statements in this Consent to Change of Name of Minor are accurate to the best of my knowledge.
 

_____________________________________________
_________________
Signature
Date


_____________________________________________
Address, Line 1

_____________________________________________

Address, Line 2



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