Notice Of Petition To Change Name Of Infant - New York Supreme Court Page 3
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7[Fill in the spaces next to the instructions. Attach copies of the indicated documents
and mark them as exhibits.]
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)
___________ /
PETITION
-against-
____________________________________________,
[23. Fill in name(s)]
Respondent(s)
-----------------------------------------------------------------------------x
TO THE SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF NASSAU:
[24. Your name]
by this petition
petition, alleges that he/she is the [25.Circle one] natural father/mother of the infant
named herein, and resides at [26. Your address]
and further alleges that:
1. Said infant's name is [27. Insert infant current name]
2. The name which said infant proposes to assume is [28. Insert infant new name]
3. Said infant resides at [29. Insert infant address, No Post Office Box.]
4. Said infant is of the age of [30. Insert infant age.]
5. Said infant date of birth is [31. Insert infant date of birth.]
6. Said infant place of birth is [32. Insert County, State and Country.]
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