Petition For Change Of Name Form With Instructions (Page 3 of 3) in pdf

Petition For Change Of Name Form With Instructions Page 3

Your petitioner further states and declares under penalty of perjury under the laws

of the State of Alabama: that the foregoing is true and correct:

Initial each correct statement:

_______That a true and correct copy of my birth certificate has been filed along with this petition;

_______That he/she has never been convicted as a Criminal Sex Offender; as provided by Act 98-489;

_______That he/she is not currently a party to any judicial proceeding in any court in any jurisdiction;

_______That he/she is not currently a defendant to any criminal charge;

_______That he/she is not attempting to avoid payment of any debt or judgment of debt;

_______That he/she is not attempting to commit fraud in any manner whatsoever;

_______That he/she has never been convicted of any felony or crime involving moral turpitude;

_______That he/she authorizes a criminal background check prior to the name change being granted;

Your petitioner prays that the Court will make such order in the premises as may be proper to

change his/her name as prayed.

DATED:______________________

__________________________________

Petitioners Signature

Address:__________________________

__________________________________

Home Phone # (205)_________________

Work/Cell Phone # (205)______________

NOTARY ACKNOWLEDGEMENT

STATE OF ALABAMA

JEFFERSON COUNTY

I, _______________________________, a Notary Public in and for said County, in said State,

hereby certify that _______________________________________ whose name is signed to the foregoing

NAME CHANGE PETITION and who is known to me, acknowledged before me, on this day, that, being

informed of the contents of this conveyance, he/she, has executed the same voluntarily, on the day the same

bears date.

Given under my hand, this the _________day of _____________, 20____.

_____________________________________

Notary Public

My commission expires:_________________

Petition For Change Of Name Form With Instructions Page 3