Change Of Name - Secretary Of State, Rhode Island
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1
2Date filed: _____________________
PC-8.1 (11/02, formerly SW-19) Change of Name
Court use only
STATE OF RHODE ISLAND
PROBATE COURT OF THE
County of ___________________________________
Estate of ____________________________________
_________________________________________________
Alias _______________________________________
Alias _______________________________________
No. ____________________
____________________
Date
CHANGE OF NAME
The undersigned petitioner requests the following name change:
[ ] self
[ ] for minor child
__________________________________________________________________________
Current Name
__________________________________________________________________________
No.
Street
__________________________________________________________________________
City/Town
State
Zip
Phone Number
__________________________________________________________________________
Mailing Address (if different) No.
Street
__________________________________________________________________________
Mailing Address (if different) City/Town
State
Zip
Name on Original Birth Record: _____________________________________________________
Date of Birth: __________________________
Place of Birth: __________________________
Mother’s Maiden Name: ____________________ Father’s Name: ____________________
Petitioner’s Occupation: ____________________________________________________________
Petitioner’s Marital Status
: ____________________________________________________
(optional)
The petitioner resided at the following addresses:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Reason for name change (be specific): _________________________________________________
Petitioner requests a name change to: __________________________________________________
If applicable, the name on the birth record should be changed to:
________________________________________________________________________________
(continued on page 2)
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