Petition For Individual Minors Change Of Name Page 2
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2PETITIONER FOR INDIVIDUAL M INOR’S CHANGE OF NAM E - PAGE 2
Index No.______________
8.
I have/have not made a previous application to change the Minor’s name in this or any other Court.
(If you have, give details and reason for this current application below.)
(Strike out one)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
9.
The reasons for this application are as follows: ___________________________________________
________________________________________________________________________________
________________________________________________________________________________
10.
W HEREFORE, your Petitioner respectfully requests that an Order be granted permitting this change of
name.
_______________________________
____________________________________
Date
Signature of Petitioner
VERIFICATION
State of New York, County of _____________ss.:
_______________________________________, being duly sworn, deposes and says:
s/he is the petitioner named above, that petitioner has read the petition and knows the truth of the contents thereof
except for those matters alleged to be on information and belief, and as to those matters, petitioner believes them to be
true.
Sworn to before me this _____ day of ____________, 20___
_________________________________________________
__________________________________
Signature of Notary Public
Signature of Petitioner
CIV-GP-82M Page 2 (Revised August 2009)
FREE CIVIL COURT FORM
No fee may be charged to fill in this form.
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