Petition For Change Of Infant'S Name - New York Supreme Court Page 5
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6SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
----------------------------------------------------------------------------x
In the Matter of the Application of
[31. Index No. & Year]
___________________________________________,
Index No.
[32. Fill in name(s)]
______________/_____
individually and as parent or guardian of the infant(s)
AFFIDAVIT OF CONSENT
OF NON-PETITIONING
___________________________________________,
PARENT
[33. Fill in infant current name]
FOR LEAVE TO CHANGE INFANT(S) NAME(S) TO
___________________________________________,
[34. Fill in infant new name(s)]
-----------------------------------------------------------------------------x
STATE OF NEW YORK}
SS. :}
COUNTY OF ____________}
[35. Insert County where papers signed and notarized]
I, _______________________________[36. Insert Name of parent who is not
the petitioner] , being duly sworn, deposes and says: I am the parent (natural
guardian) of the infant in the within proceeding. I have read the foregoing petition for
change of infants name of [37. Insert the name(s) of the petitioner]
and joins in the prayer for relief and consents thereto.
___________________________
___________________________
[38. Signature of Non-petitioning Parent]
__________________________
_________________________________
[39. Print Name of Non-petitioning Parent]
Sworn to before me this
day of ______________, 20 __
___________________________
Notary Public
[40. Affidavit must be notarized]
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