Petition For Name Change - Kentucky Court Of Justice
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1AOC-295
Doc. Code: PNC
Case No.
Rev. 10-08
Page 1 of 1
Court
Commonwealth of Kentucky
Court of Justice
County
PETITION FOR NAME CHANGE
KRS Chapter 401
IN RE: CHANGE OF NAME FOR _____________________________________________________________________
COME(S) THE PETITIONER(S), (choose one):
__________________________________________ and _____________________________________________,
living parents of the above-captioned minor (minor refers to child under age 18, see KRS 401.020); or
____________________________________________________, surviving parent of above-captioned minor; or
_________________________________________________________, guardian of above-captioned minor; or
above-captioned adult, AND IN SUPPORT OF THIS PETITION STATE(S):
1. The original name is
.
2. The desired name change is
.
3. Birthdate (MM/DD/YY) of minor/adult is
.
4. Birth location (city, county, state) of minor/adult is:
,
,
.
5. Minor/Adult currently resides in the county in which this Petition is filed. His/Her address is:
6. Purpose of desired name change is:
. I understand identity theft is a Class D Felony
in Kentucky. KRS 514.160. I am not requesting this name change to avoid a legal obligation or evade prosecution.
7. For petition of minor with two living parents: Per KRS 401.020, if a parent refuses or is unavailable to execute this
Petition, proper notice of its filing shall be made on absent parent pursuant to the Rules of Civil Procedure.
Father:
Address:
Mother:
Address:
WHEREFORE, Petitioner(s) pray(s) for an Order for Change of Name.
Dated:
, 2
.
Petitioner’s Signature
Petitioner’s Signature
Attorney Name:
HEARING
Subscribed and sworn to before me on
Schedule hearing for
, 2
, 2
.
at
a.m.
p.m.
My commission expires:
, 2
.
Judge
Notary
Note: File this Petition in the Circuit Clerk’s Office in the county in where you reside.
Distribution for Hearing Notice: Petitioner(s) OR Attorney for Petitioner(s), if any
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