Change Of Name Form

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Change of Name
CHNGNAME(03/96)
UNITED STATES OF AMERICA
STATE OF ILLINOIS
COUNTY OF LASALLE
IN THE CIRCUIT COURT OF THE THIRTEENTH JUDICIAL CIRCUIT
IN THE MATTER OF THE PETITION OF
_______________________________________
_______________________________________
Case No.____________
_______________________________________
For change of name
CHANGE OF NAME
TO THE HONORABLE JUDGE OF THE CIRCUIT COURT
Your petitioner____________________________________________ respectfully shows that __________(is/are) a
resident of the State of Illinois, and (has/have) resided in the County of LaSalle in said state for more than 6 months prior
to the filing of this petition; that _________ desires to change _______ name, according to the provisions of the Statute in
such case made and provided, and _________now, in that behalf, respectfully shows that ______ now bears the name of:
________________________________________________________________ and is known and called by this name;
that___________desires to assume the name of ________________________________________________________
by which ________ may be hereafter known and called. That ___________ respective place of nativity and age is as
follows: _____________________________________________________________________________________
That ______(has/have) resided in the State of Illinois for _____ years last past. That _______(has/have) given notice of
this, ________ intended application by publication in ___________________________________________ a news-
paper published in LaSalle County of general circulation, for three consecutive weeks, a copy of which published notice,
with the certificate of the publisher thereon is hereto annexed and made part of this petition.
WHEREFORE, Your petitioner prays, the premises being considered, that _______ name be changed from its present
form to _____________________________________________________________________________ as pro-
vided by Statute, and that _______hereafter be known and called by the last aforesaid name, and that ______(has/have)
such other or future relief in the premise as this Honorable Court shall seem met, according to law.
Name:___________________________________________
________________________________________________
Attoney for Petitioner(s)
Address:_________________________________________
________________________________________________
City:____________________________________________
________________________________________________
Phone:__________________________________________
________________________________________________
AFFIDAVIT
___________________________________________________ being duly sworn on oath deposes and says that _________ (is/are)
acquainted with _____________________________________________________________________________________ the pe-
titioner in this cause, who has signed this petition; that ___________(has/have) hereby read this petition, and knows the contents
thereof , and that the same, and the matters and things herein stated are true.
________________________________________________
Affiant
Sworn and Subscribed to before me
___________________________________, 20____________
________________________________________________
Notary Public - Court Clerk
LASALLE COUNTY CIRCUIT CLERK
OTTAWA, ILLINOIS 61350

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