IN DISTRICT COURT,
COUNTY, NORTH DAKOTA
Case No.
IN THE MATTER OF THE PETITION FOR A NAME CHANGE OF
(full name of Petitioner)
AFFIDAVIT OF PETITIONER
I, ____________________________________________________________________,
the undersigned, being first sworn, on my oath state that the following is true to the best of my
knowledge:
1.
My full, legal name is ______________________________________________________,
and I am the Petitioner.
permanent resident alien (choose one) of the United States.
2.
I am a
citizen (OR)
3.
I have been a resident of North Dakota for ______ years and ______ months.
4.
I have been a resident of _______________________ County, North Dakota, for more
than six months immediately preceding the date of the Petition for Name Change.
My place of birth is ______________________________________________ (city, state).
5.
6.
My year of birth is _____________.
I petition the court to change my name to: (requested full, legal name)
7.
______________________________________________________________________________
For the following reasons:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
NDLSHC
Page 1 of 4
NC Aff/Rev. Sep 2017