Affidavit In Support Of Nunc Pro Tunc Order Change Of Adult'S Name - New York Supreme Court Page 3
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3SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
----------------------------------------------------------------------------x
In the Matter of the Application of
[18. Index No. & Year]
,
Index No.
[19. Fill in name(s)]
______________/_____
FOR LEAVE TO CHANGE NAME TO
AFFIDAVIT IN SUPPORT
OF NUNC PRO TUNC
ORDER CHANGE OF
,
ADULT’S NAME
[20. Fill in new name]
-----------------------------------------------------------------------------x
_____________________________________________________________________
_____________________________________________________________________
[21. Insert name(s) of papers submitted]
[22. YOUR SIGNATURE]
____________________
___________________
[23. PRINT YOUR NAME]
[24. YOUR ADDRESS]
[25. CITY, STATE ZIP CODE]
[26. YOUR PHONE NUMBER]
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