OHIO PETITION FOR CHANGE OF NAME OF ADULT
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Petition for Change of Name of Adult
State of Ohio County of ________________ |
Court _____________________________ Docket No. ________________________ |
Name of Petitioner:_____________________________ | In re: Change of Name of Adult |
From: _____________________________ To: _______________________________ |
Petitioner makes the following declaration:
1. Birth Date and Place: Petitioner was born on _______________________, ______ in ________________________ [city], ________________________ [county], ________________________ [state]. A certified copy of petitioner's birth certificate is attached to this petition.
2. Birth Name: Petitioner was named
____________________________________________ at birth, and as of the date of
this petition, the Petitioner has always been known by that name, with the
following exceptions, if any:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
[list all legal names previously held].
3. Residence: Petitioner resides at _______________________ [insert residential address] and has lived at this address for ________ [insert length of time in months or years at this address].
4. Petitioner's Parents: The father of the Petitioner is named ______________________________________________, and he resides at _____________________________________________________________________________ [insert residential address of father]. The mother of the Petitioner is named ______________________________________________, and she resides at _____________________________________________________________________________ [insert residential address of mother].
5. Reason for Name Change: Petitioner seeks to change his or her
name to ______________________________________________ and offers the following
reason(s) for seeking to do so:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________.
6. Legal and Creditor Status: Petitioner does not have any outstanding judgments, has never been convicted of a crime, and is not involved in any pending legal actions.
7. Additional Declarations: In addition to the foregoing
statements, the Petitioner further declares:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
[insert additional declarations, if any].
NOW, THEREFORE, the Petitioner requests that the court order the Petitioner's name changed as follows:
From: ____________________________________________ To: ______________________________________________ |
Verification
I, ______________________________________________[name of Petitioner], affirm under penalty of
perjury that I am the Petitioner in the foregoing Petition to
Change Name of Adult and that all statements in this Petition are accurate to the best of my
knowledge.
_____________________________________________ | _________________ |
Petitioner's Signature | Date |
_____________________________________________ Petitioner's Address, Line 1 _____________________________________________ |
|
Petitioner's Address, Line 2 |
Subscribed and sworn to before me on this ____ day of __________________,
20_____.
__________________________________
Notary
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