Petition For Change Of Adult'S Name - New York Supreme Court Page 3
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6instrument or otherwise against me or to which said I am a party. I have no creditors and
no person will be adversely affected nor prejudiced in any way by the proposed change of
name. Except as stated below: [13. If any of the above statements are not true,
complete an explanation of circumstances below]
11. I hereby state under the penalty of perjury that: I have not been convicted of a
crime. Except as stated below:
[14. If any of the above statements are not true,
complete an explanation of circumstances below]
12. No previous application has been made for this relief before this or any other
court of competent jurisdiction. Except as stated below:
[15. If any of the above
statements are not true, complete an explanation of circumstances below]
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