Free State of Minnesota - Minnesota

State of Minnesota
County
Select County

District Court
Judicial District: Court File Number: Case Type: Name Change

In the Matter of the Application of:
First Middle Last

On Behalf of (current name of minor(s)):

First

Middle

Last

Application for Name Change of a Minor (Minn. Stat. § 259.10)

For a change of name to (new name of minor(s)):
First Middle Last

The undersigned applicant has sworn/affirmed on oath and states that: 1. This application is made in good faith, without intent to defraud or mislead. 2. The minor child(ren) whose name(s) are sought to be changed on this application have lived in the State of Minnesota for at least six months immediately prior to the date of this application, and now live at:
No. City/Town Street State Zip County

3. I am/we are the: (check one) of the minor child(ren).

parent(s)

legal guardian

next of kin (specify):

4. The current name(s) of minor child(ren) and date(s) of birth:

5. The name of the non-applicant parent(s): The non-applicant parent is not known and his/her/their name(s) is/are not shown on the birth certificate. 6. The address of the non-applicant parent(s) is/are:
No. City/Town State Zip Street County

7. Applicant requests to have the name(s) of the minor child(ren) changed to:

8.

The criminal history of the following parties included in this application is: ____________________________ _________________________________________________________________________________________ The following parties included in this application have been convicted of a felony:
List name, date of offense, and state. If no criminal history, write "No criminal history." If no felony convictions, write "No felony convictions."

NAM202

State

ENG

Rev 8/08

www.mncourts.gov/forms

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9. Legal description of lands in the State of Minnesota upon which the minor child(ren) has/have a claim, interest, or lien: (Provide the legal description and attach additional pages if necessary)

10. Other: Dated:
Co-Applicant's Signature (Spouse) Applicant's Signature Address City Telephone Number State Zip

State of Minnesota
County of

Verification

, being duly sworn on oath, says that he/she has read the foregoing application and knows the contents thereof, and that the same is true of his/her own knowledge. Subscribed and sworn to before me Date:

Deputy Court Administrator / Notary Public

Applicant's Signature

My Commission Expires Co-applicant's Signature

NAM202

State

ENG

Rev 8/08

www.mncourts.gov/forms

Page 2 of 2