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Petition for Change of Name (Minor)
Page 1 of 3
DR 62 - Revised 13 February 2001
IN THE MATTER OF:
*
IN THE

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CIRCUIT COURT
(childs current name)

*
FOR
(street address)

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__________________________________
(city, state, zip)

*
(phone number)
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FOR CHANGE OF NAME TO:
*

(childs new name)
*
BY AND THROUGH HIS/HER
*
Civil No.:
MOTHER/FATHER/GUARDIAN:
*

(petitioners name)
*
*
*
*
*
*
*
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*
*
*
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PETITION FOR CHANGE OF NAME
(Minor)
(DOM REL 62)
TO THE HONORABLE, THE JUDGE OF SAID COURT:
Petitioner, , a minor, by and
through
(childs current name)
his/her
Mother / Father / Guardian (check one) respectfully represents to this Court:
1. That the minor child was born on , in ,
(childs birthdate) (childs birthplace - city, state, country)
and presently resides at .
(childs present address)
2. That the childs birthname is .
(childs birth name)

[ ]
The childs name has been changed to the following since birth for the following
reasons (List any reasons why the childs name may have been changed since
birth, for example, adoption).
Name Changed To:
Reason:





Page 2 of 3
DR 62 - Revised 13 February 2001
[ ]
I have attached a birth certificate or other document reflecting the childs current
name
3. Petitioner wishes to change the childs name to : .
(childs new name)
4. This change of name is being requested because:
5. The name and address of each parent, guardian and custodian of the child is:

6. The other parent, guardian or custodian:
[ ]
Consents to and joins this petition.
[ ]
Has not consented at this time.
[ ]
Cannot be found, and I have attached an Affidavit and Motion to Serve by
Alternative Means.
7. Petitioner hereby certifies that the above change of name is not requested for any
illegal or fraudulent purposes.
WHEREFORE, I respectfully request that the Court pass an Order changing the minor
childs name from to .
(current name) (new name) Page 3 of 3
DR 62 - Revised 13 February 2001
I, , solemnly affirm under the penalties
(your current name - MOTHER/FATHER/GUARDIAN)
of perjury, that the contents of the foregoing paper are true to the best of my knowledge,
information and belief.


(Date)
(Your Signature -- MOTHER/FATHER/GUARDIAN)

(Your Name - Printed)

(Address)

(City, State, Zip)

(Telephone Number)