Free PC-900 - Connecticut

APPLICATION FOR CHANGE OF NAME (MINOR) PC-900 REV. 10/05

STATE OF CONNECTICUT COURT OF PROBATE [Type or print in black ink.] DISTRICT NO.

RECORDED:

TO: COURT OF PROBATE, DISTRICT OF IN RE CHANGE OF NAME OF

DATE OF APPLICATION

PETITIONING PARENT/GUARDIAN: NAME: PRESENT ADDRESS:

MOTHER

FATHER OR

GUARDIAN TELEPHONE NUMBER:

NAME, ADDRESS, AND TELEPHONE NUMBER OF ANY NON-PETITIONING PARENT/GUARDIAN:

Check any boxes that apply:

The NON-PETITIONING parent and the petitioning parent: There is an outstanding superior court order for

are divorced visitation

have never been married. child support.

Explain why the non-petitioning parent is not joining in this petition:

CO-PETITIONER: NAME: PRESENT ADDRESS:

MOTHER

FATHER TELEPHONE NUMBER:

MINOR PETITIONER(S) THROUGH PARENT(S) AS NEXT FRIEND [Give name(s), new name(s), and date(s) and place(s) of birth.] NAME:
First Middle Last

CHANGED TO:
First Middle Last

PRESENT ADDRESS: DATE OF BIRTH AND PLACE OF BIRTH: SOCIAL SECURITY NUMBER: NAME:
First Middle Last

CHANGED TO:
First Middle Last

PRESENT ADDRESS: DATE OF BIRTH AND PLACE OF BIRTH: SOCIAL SECURITY NUMBER: A change of name is sought for the following reasons:

The petitioner(s) represent(s) that the purpose of seeking a change of name is not to deceive, defraud, or mislead any person or governmental agency but solely for the reason(s) stated above. WHEREFORE, the petitioner(s) as indicated above, request(s) a change of name to the name(s) stated above. The representations contained herein are made under the penalties of false statement. SIGNED: PETITIONER.............................................................................................. CO-PETITIONER ..................................................................................................... APPLICATION FOR CHANGE OF NAME (MINOR) PC-900
RESET

Date: Date: