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North Carolina Name Change Petition

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									                                   Change of Name of Adult Petition

State of _______________                            Court _____________________________
County of ________________                          Docket No. ________________________

Name of Petitioner(s):                              In re: Change of Name of Adult

________________________________                    From: _______________________________
     First            Middle              Last                        Previous Legal Name
                                                    To: _________________________________
                                                                       New Legal Name

      Petitioner(s) makes (make) the following declaration:

      I. Petitioner’s Birth Name: The petitioner’s name at birth was

             ______________________________________________________________

                      First                       Middle                      Last

             and until the date of this petition, the petitioner has always been referred to as
             this name or:


             _____________________________________________________________________

                              List Name(s) Petitioner has been known as (if any)

      II. Birth Date and Place: The petitioner was born on _____________________,

                                                                            Date

      In the City of _____________________, County of _______________________,

                                       City                               County

      State of _______________________.

                               State
III. Petitioner’s Residency: The petitioner’s official legal address is

________________________________________________________________

                                    Street Address

City of ________________, County of _________________, State of _________

               City                             County                    State

and has resided at this address for approximately _______ years.

IV. New Name & Reason for Name Change: Petitioner seeks to change name
to

________________________________________________________________

                               Petitioner’s New Legal Name

for the following reason(s):

________________________________________________________________

V. Outstanding Judgments: The Petitioner does not have any outstanding
judgments, has never been convicted of a crime, and is not involved in any
pending legal actions.

VI. Additional Declarations: In addition to the foregoing statements, the
Petitioner(s) further declares

________________________________________________________________

                           Additional Declarations (if any)

NOW, THEREFORE, the Petitioner(s) requests (request) that the court order the
Petitioner's name changed as follows:

From: ____________________________________________
                          Previous Legal Name
To: ______________________________________________
                           New Legal Name

                                           

                                                                                            Verification (Petitioner)

I,_______________________________________________________________

                                                                                                 Petitioner Legal Name

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. 


_________________________________________	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  _______________________________	
  
Signature	
  of	
  Petitioner	
  #1	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  Date	
  
	
  


                                                                                        Notary Acknowledgement	
  

State of ___________ County of ______________________________ Subscribed,
Sworn and acknowledged before me by ______________________________, the
Principal, and subscribed and sworn to before me by ______________________,
witness, this ______________________ day of ________________________.

______________________________
Notary Signature

Notary Public
In and for the County of ______________________________
State of ______________________________
My commission expires: ______________________________                                                                                                                                                            Seal

								
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