Petition For Change Of Infant'S Name - New York Supreme Court Page 4

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[Fill in the spaces next to the instructions.]
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
----------------------------------------------------------------------------x
In the Matter of the Application of
[21. Index No. & Year]
___________________________________________,
Index No.
[22. Fill in name(s)]
Petitioner(s)
___________ /
VERIFICATION
-against-
____________________________________________,
[23. Fill in name(s)]
Respondent(s)
-----------------------------------------------------------------------------x
STATE OF NEW YORK}
SS. :}
COUNTY OF ____________}
[24. Insert County where papers signed and notarized]
_______________________________[25. Insert Your Name] , being duly
sworn, deposes and says: I am the__________________________ [26. Insert
Petitioner or Respondent] in this matter.
I have read the foregoing [27. Insert the name(s) of the above documents e.g.
affidavit, petition etc.]
and know the contents thereof.
The same are true to my knowledge, except as to matters therein stated to be alleged
on information and belief and as to those matters I believe them to be true
_
_____________________________
[28. SIGN YOUR NAME BEFORE NOTARY]
_________________________________
[29. PRINT YOUR NAME]
Sworn to before me this
day of ______________, 20 __
___________________________
Notary Public
[30. Verification must be notarized]

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