IN THE SUPREME COURT OF VIRGINIA In the Matter of: Application for Change in Name To the Honorable Chief Justice and Justices of the Supreme Court of Virginia Your petitioner, _______________________, respectfully represents that she was duly licensed to practice law in the Commonwealth of Virginia on _______________________, and that she qualified to practice law in this Honorable Court on __________________________. Your petitioner further represents that she was lawfully married to _______________________on ____________________, a certified copy of such certificate of marriage being attached hereto. Wherefore, your petitioner prays that the official records of this Court be changed to show that the petitioner's name is _______________________ rather than _______________________, and further prays that your petitioner be permitted to practice law in this Commonwealth under the name of _______________________. Respectfully submitted this ______ day of __________________, 20______. ____________________________ Petitioner Fee $14.00 (includes new certificate; $10.00 if no certificate desired) Return form to: Supreme Court of Virginia Supreme Court Building Clerk's Office, 5th Floor 100 North 9th Street Richmond, Virginia 23219
**PLEASE DO NOT STAPLE YOUR CHECK OR MONEY ORDER TO THE APPLICATION. **PLEASE NOTE THAT YOUR MARRIAGE LICENSE MUST BE AN ORIGINAL CERTIFIED COPY. IF YOU WISH IT TO BE RETURNED TO YOU, PLEASE ADVISE THIS OFFICE WHEN SENDING YOUR APPLICATION.