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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.982(a), PETITION FOR CHANGE OF NAME (ADULT) When should this form be used? This form should be used when an adult wants the court to change his or her name. This form is not to be used in connection with a divorce action. If you want a change of name because of a dissolution of marriage that is not yet final, the change of name should be done as part of that case. This form should be typed or printed in black ink. You must obtain a copy of your fingerprints taken by a law enforcement agency and attach it to the petition. There may be a charge for the fingerprinting which you will have to pay. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. What should I do next? Next, you must obtain a hearing date for the court to consider your request. You should ask the clerk of court, family law intake staff, or judicial assistant about the local procedure for setting a hearing. You may be required to attend the final hearing. Included in these forms is a Final Judgment of Change of Name (Adult), O" Florida Supreme Court Approved Family Law Form 12.982(b), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant, to see if you need to bring a final judgment form with you. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. If the judge grants your petition, he or she will sign this order. This officially changes your name. The clerk can provide you with certified copies of the signed order. There will be charges for the certified copies, and the clerk can tell you how much those charges are. Where can I look for more information? Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. For further information, see section 68.07, Florida Statutes. Special notes... The heading of the form calls for the name of the petitioner. Your current name should go there, as you are the one who is asking the court for something. The judicial circuit, case number, and division may be obtained from the clerk of court's office when you file the petition. It may be helpful to compile a list of all of the people and/or places that will need a copy of your final judgment. This list may include the driver's license office, social security office, banks, schools, etc. A list will help you know how many copies of your order you should get from the clerk of court after your hearing. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, O` Florida Family Law Rules of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms also
Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (11/04)

must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (11/04)

IN THE CIRCUIT COURT OF THE IN AND FOR

JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division:

IN RE: THE NAME CHANGE OF , Petitioner. PETITION FOR CHANGE OF NAME (ADULT) I, {full legal name} the following information is true: 1. My complete present name is: I request that my name be changed to: I live in County, Florida, at {street address} . 3. I was born on {date} {state} My father's full legal name: My mother's full legal name: My mother's maiden name: I have lived in the following places since birth: Dates (to/from) Address / / / / / / / / / / 9 Check here if you are continuing these facts on an attached page. 6. Family [ / all that apply] a. I am not married. b. I am married. My spouse's full legal name is: , in {city} , {country} , {county} , . . . . , being sworn, certify that . .

2.

4.

5.

.

Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (11/04)

c. I do not have child(ren). d. The name(s), age(s), and address(es) of my child(ren) are as follows (all children, including those over 18, must be listed): Name {last, first, middle initial} Age Address, City, State

G Check here if you are continuing these facts on an attached page.
7. Former names [ / all that apply] My name has never been changed by a court. My name previously was changed by court order from to on {date} , . by {court, city, and state} A copy of the court order is attached. My name previously was changed by marriage from to on {date} , . in {city, county, and state} A copy of the marriage certificate is attached. I have never been known or called by any other name. I have been known or called by the following other name(s): {list name(s) and explain where you were known or called by such name(s)} . 8. Occupation My occupation is: I am employed at: {company and address} During the past 5 years, I have had the following jobs: Dates (to/from) Employer and employer's address / / / / / / / 9 Check here if you are continuing these facts on an attached page. 9. Business [ / one only] I do not own and operate a business. I own and operate a business. The name of the business is: The street address is: My position with the business is:
Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (11/04)

. .

. . .

I have been involved with the business since: {date} 10. Profession [ / one only] I am not in a profession. I am in a profession. My profession is: I have practiced this profession: Dates (to/from) Place and address / / / / / 9 Check here if you are continuing these facts on an attached page. 11. Education I have graduated from the following school(s): Degree Date of Received Graduation School

.

.

G Check here if you are continuing these facts on an attached page.
12. Criminal History [ / one only] I have never been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. I have a criminal history. In the past I have been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. The details of my criminal history are: Date City/State Event (arrest, charge, plea, or adjudication)

9 Check here if you are continuing these facts on an attached page.
13. Bankruptcy [ / one only] I have never been adjudicated bankrupt. I was adjudicated bankrupt on {date} , in {city} , {state} . {county} 9 Check here if you have filed additional bankruptcies, and explain on an attached page.

,

Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (11/04)

14. Creditor(s)' Judgments [ / one only] I have never had a money judgment entered against me by a creditor. The following creditor(s)' money judgment(s) have been entered against me: Date Amount Creditor Court entering judgment and case number

/ if Paid 9 9 9 9

9 Check here if these facts are continued on an attached page.
15. 16. Fingerprints A copy of my fingerprints taken by a law enforcement agency is attached to this petition. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or otherwise. My civil rights have never been suspended, or, if my civil rights have been suspended, they have been fully restored.

17.

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: . Signature of Petitioner
Printed Name: Address: City, State, Zip: Telephone Number: Fax Number:

STATE OF FLORIDA COUNTY OF Sworn to or affirmed and signed before me on by NOTARY PUBLIC or DEPUTY CLERK [Print, type, or stamp commissioned name of notary or deputy clerk.] Personally known Produced identification Type of identification produced .

Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (11/04)

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ N fill in all blanks] , I, {full legal name and trade name of nonlawyer} , {city} , a nonlawyer, located at {street} , {phone} , helped {name} , {state} who is the petitioner, fill out this form.

Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (11/04)