Doc. Code: PNC
Page 1 of 1
Commonwealth of Kentucky
Court of Justice
PETITION FOR NAME CHANGE
KRS Chapter 401
IN RE: CHANGE OF NAME FOR _____________________________________________________________________
COME(S) THE PETITIONER(S), (choose one):
__________________________________________ and _____________________________________________,
living parents of the above-captioned minor (minor refers to child under age 18, see KRS 401.020); or
____________________________________________________, surviving parent of above-captioned minor; or
_________________________________________________________, guardian of above-captioned minor; or
above-captioned adult, AND IN SUPPORT OF THIS PETITION STATE(S):
1. The original name is
2. The desired name change is
3. Birthdate (MM/DD/YY) of minor/adult is
4. Birth location (city, county, state) of minor/adult is:
5. Minor/Adult currently resides in the county in which this Petition is filed. His/Her address is:
6. Purpose of desired name change is:
. I understand identity theft is a Class D Felony
in Kentucky. KRS 514.160. I am not requesting this name change to avoid a legal obligation or evade prosecution.
7. For petition of minor with two living parents: Per KRS 401.020, if a parent refuses or is unavailable to execute this
Petition, proper notice of its filing shall be made on absent parent pursuant to the Rules of Civil Procedure.
WHEREFORE, Petitioner(s) pray(s) for an Order for Change of Name.
Subscribed and sworn to before me on
Schedule hearing for
My commission expires:
Note: File this Petition in the Circuit Clerk’s Office in the county in where you reside.
Distribution for Hearing Notice: Petitioner(s) OR Attorney for Petitioner(s), if any