Petition For Change Of Adult'S Name - New York Supreme Court Page 2
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66. I am
Single
Married
Divorced
Separated.
7. The petitioner
is
is not
responsible for child support obligation.
[10. If the petitioner is responsible for child support obligations attach a
separate statement.]
8. The petitioner
is
is not
responsible for a maintenance/ alimony obligation.
[11.If the petitioner is responsible for maintenance/alimony obligations attach
a separate statement.]
9. I wish to change my name for the following reasons
[12. Explain your reasons for the application.]
10. I hereby state under the penalty of perjury that: I have no judgments or liens of
record against said me nor against any property in my name. I am not party to any action
or proceeding is pending. I have never been adjudicated a bankrupt. In fact, no proceeding
in bankruptcy has ever been instituted by or against mein any court or before any officer
of the state or of the United States, nor have I at any time made an assignment for the
benefit of creditors. There are no claims, demands, liabilities or obligations on a written
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