Free Petition for a Change in Name by an Applicant for Citizenship - Federal

AO 115 (Rev. 01/09) Petition for a Change in Name by an Applicant for Citizenship

UNITED STATES DISTRICT COURT
for the __________ District of __________

PETITION FOR A CHANGE IN NAME BY AN APPLICANT FOR CITIZENSHIP Instructions to the Applicant for Citizenship: The Immigration and Nationality Act authorizes a United States district court to change the name of an applicant for citizenship at the same time that the court administers the oath of allegiance. The naturalization certificate will then show your new name. If you wish to change your name at the time of the naturalization ceremony, provide the following information: (1) My full name now is: (2) My place of residence is: (3) My country of birth is: (4) My date of birth is: (5) My alien registration number is: Petition to the Court: I certify that I am not seeking a change in name for any unlawful purpose, such as to avoid debt or evade law enforcement. I ask the court to change my name to: . . . . .

Date:
Petitioner's signature

Certification of Name Change I certify that the court granted this change in name on (date) .

Date: CLERK OF COURT

Signature of Clerk or Deputy Clerk

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