Commonwealth of Massachusetts
Division Name of Petitioner
(Street address)

The Trial Court Probate and Family Court Department

Docket No.

Change of Name(s)
(City/Town) (State) (Zip)

Date of Birth Name of Spouse Date of Birth Names of Minor Children

Place of Birth Place of Birth

Reason for change

Have parties ever changed their names before?

If answer is yes, explain

Petitioner(s) request(s) that his/her/their name(s) be changed as follows: Name at Present: Petitioner Spouse Child Child Child Date To be changed to:

SIGNATURE OF PETITIONER

SIGNATURE OF SPOUSE

DECREE

Signature of Minor(s) as signed by father or mother as next friend.

Notice having been given according to the order of the Court, and no objection being made, it is decreed that the above name(s) be changed as requested, which name(s) he/she/they shall hereafter bear, and which shall be his/her/their legal name(s). Date
CJ-P 27 (5/07)

JUSTICE OF THE PROBATE AND FAMILY COURT

C.G.F.