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 PETITIONER OR ATTORNEY (Name, state bar number, and address):                                                                                               FOR COURT USE ONLY

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           TELEPHONE NO.:                                         FAX NO. (Optional):
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    ATTORNEY FOR (Name):

                                     COUNTY . .
                                     . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
                                                                                                                                            :    Index No.

        CITY AND ZIP CODE:                                                                                                                 :     Calendar No.
             BRANCH NAME:
  PETITION OF (Names of each petitioner):                                                                  Plaintiff(s)                          JUDICIAL SUBPOENA
                                                                               -against-                                                   :

                                   PETITION FOR CHANGE OF NAME                                                                                  CASE NUMBER:

  Before you complete this petition, you should read the Instructions for Filing a Petition for Change of Name on the next page. You must
  answer all questions and check all boxes on this petition that apply to you. You must file this petition in the Superior Court of the county
                                                                                          Defendant(s)                     :
  where the person whose be . . . . . . . . resides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
                             . . . . . . changed . . . . . . .

1. Name of each petitioner:
                                     THE PEOPLE OF THE STATE OF NEW YORK

2. Petitioner requests that the court decree the following name changes (list every name that you are seeking to change):
                                    Present name                                                                                                       Proposed name
   a.                                                                                             changed to
   b.                                                                                             changed to
   c.                                                                          changed to
                                              WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
                                     the Honorable                                        at the               Court                                         ,
   d.                                County of                                 changed to
                                                                         located at
   e.                                in room            , on the                          ,
                                                                       day of changed to 20       , at         o'clock in the      noon, and at any recessed
                                     or adjourned date, to testify and give evidence as a witness in this action on the part of the

          Continued (if you are seeking to change additional names, you must prepare a list and attach it to this petition as Attachment 2).
                                        Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
3. Petitioner requests that the court issue an order directing all interested persons maximum penalty of $50 andwhydamages sustained as a
                              the party on whose behalf this subpoena was issued for a to appear and show cause all this petition for change
   of name of the persons identified in item 2 should not be granted.
                              result of your failure to comply.

4. The number of persons under 18 years of age whose names are to be changed is (specify):
                                        Witness, Honorable                                           , one of the Justices of the
                               Court in             County,    day of           , 20
5. If this petition requests the change of name of any person or persons under 18 years, this request is being made by
   a.        both parents.
   b.        mother only.                                                             (Attorney must sign above and type name below)
   c.        father only.
   d.        near relative (name and relationship):
   e.        guardian (name):                                                         Attorney(s) for
    f.       other (specify):

6. For each person whose name is to be changed, petitioner provides the following information (you must attach a separate copy of
                                                                                      Office and NC-110) for
   the attachment Name and Information About the Person Whose Name Is to Be Changed (formP.O. Address each person identified
   in item 2):
   a.     The number of attachments included in this petition is (specify number):
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