Petition For Change Of Family Name Page 2
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2PETITION FOR FAMILY CHANGE OF NAME - PAGE 2 of 2
Index no.
8.
W HEREFORE, your Petitioner(s) respectfully request(s) that an Order be granted permitting this requested change of name.
__________________________
__________________________________
Date
Signature of Petitioner
__________________________________
_
Signature of Second Adult
CONSENTS
I, _________________________________, am 14 years of age or over, and less than 18 years of age, and I have read
the annexed petition for family change of name, and I consent to the same.
___________________________________
_______________________________
Date
Signature
I, _________________________________, am 14 years of age or over, and less than 18 years of age, and I have read
the annexed petition for family change of name, and I consent to the same.
___________________________________
_______________________________
Date
Signature
I, _________________________________, am 14 years of age or over, and less than 18 years of age, and I have read
the annexed petition for family change of name, and I consent to the same.
___________________________________
_______________________________
Date
Signature
I, _________________________________, am 14 years of age or over, and less than 18 years of age, and I have read
the annexed petition for family change of name, and I consent to the same.
___________________________________
_______________________________
Date
Signature
VERIFICATION
State of New York, County of ___________ss.:
_____________________________________________________________, being duly sworn, deposes and say(s):
s/he/they is(are) the petitioner(s) named above, that s/he/they has/have read the petition and know(s) the truth of the contents
thereof except for those matters alleged to be on information and belief, and as to those matters, s/he/they believe(s) them to be
true, and that the signature(s) of the consenting party (parties) above is/are the true signature(s) of the minor child(ren) who is/are
included in the petition.
__________________________________
____________________________________________
Signature of Petitioner
Signature of Second Adult
Sworn to before me this ____ day of ________, 20___
Sworn to before me this _____ day of _________, 20___
_______________________________________
_______________________________________
Signature of Notary Public
Signature of Notary Public
CIV-GP-82F Page 2 (Revised September 2009)
FREE CIVIL COURT FORM
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