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Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 1 of 15
CIVIL-LAW
Name Change
- Adult
Revised November 1, 2019
uHow to Ask the Court to Change Your Name - Adults Only
(For Use in the Superior Court of New Jersey - Law Division - Civil Part)
Who Should Use This Packet?
If you are over the
age of 18, you may use this packet to ask for a court order to change your name.
However, if you are requesting a name change due to a change in your marital status please note the
following:
•
If you want to change your name as a result of a recent marriag
e, you do not need to use this packet
and may apply for a new social security card free of charge with the Social Security Administration
office.
•
Similarly, if you wish to resume your maiden name as the result of a divorce, a motion may be filed and
heard in the Family Part as part of a pending or post-judgment dissolution action. If your judgment of
divorce stipulates that you may resume your maiden name, you do not need to use this packet, and may
apply for a new social security card free of charge with the Social Security Administration office.
Do
not use this packet if:
•
You are requesting a nam
e change for your child under the age of 18; instead use the packet entitled
“How to Ask the Court to Change a Name in the Chancery Division, Family Part.”
•
You want to correct a mistake on a birth certificate, marriage license, civil union or domestic
partnership record (for example, incorrect or misspelled name or misstatement of gender). You
should contact the State Registrar of Vital Statistics directly regarding these changes. (Vital
Records in New Jersey)
Note: These materials have been prepared by the New Jersey Administrative Office of the Courts for use by self-
represented litigants. The guides, instructions, and forms will be periodically updated as necessary to reflect current
New Jersey statutes and court rules. The most recent version of the forms will be available at the county courthouse or
at njcourts.gov. However, you are ultimately responsible for the content of your court papers.
Completed forms are to be submitted to the county where you are filing your case. A list of Superior
Court Offices is provided at the customer counter or at njcourts.gov.
Name Change - Adult
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 2 of 15
Things to Think About Before You Represent Yourself in Court
Try to Get a Lawyer
The court system can be confusing and it is a good
idea to get a lawyer if you can. The law, the proofs
necessary to present your case, and the procedural
rules governing cases in the Law Division, Civil
Part are complex. Since valuable claims or
potentially heavy judgments may be at stake, most
litigants appearing in the Law Division, Civil Part
have a lawyer. If you are being sued, please contact
your insurance company to see if they might
provide a lawyer for you. Most likely your
opponent will be represented by a lawyer. It is
recommended that you make every effort to obtain
the assistance of a lawyer. If you cannot afford a
lawyer, you may contact the legal services program
in your county to see if you qualify for free legal
services. Their telephone number can be found
online or in your local yellow pages under “Legal
Aid” or “Legal Services.”
If you do not qualify for free legal services and need
help in locating an attorney, you can contact the bar
association in your county. That number can also
be found in your local yellow pages. Most county
bar associations have a Lawyer Referral Service.
The County Bar Lawyer Referral Service can
supply you with the names of attorneys in your area
willing to handle your particular type of case and
will sometimes consult with you at a reduced fee.
There are also organizations of minority lawyers
throughout New Jersey, as well as organizations of
lawyers who handle specialized types of cases. Ask
your county court staff for a list of lawyer referral
services that include these organizations.
If you decide to proceed without an attorney, these
materials explain the procedures that must be
followed to have your papers properly filed and
considered by the court. These materials do not
provide information on the law governing your
claims or defenses; information on how to conduct
pretrial discovery; information on alternative
dispute resolution procedures, such as arbitration or
mediation, that may be available or required in your
case; information on the kinds of evidence you need
to prove your claims or defense at trial; or
information on other procedural and evidentiary
rules governing civil law suits.
What You Should Expect If You Represent
Yourself
While you have the right to represent yourself in
court, you should not expect special treatment, help
or attention from the court. The following is a list
of some things court staff can and cannot do for
you. Please read it carefully before asking court
staff for help.
• We can explain and answer questions about
how the court works.
• We can tell you what the requirements are to
have your case considered by the court.
• We can give you some information from your
case file.
• We can provide you with samples of court
forms that are available.
• We can provide you with guidance on how to
fill out forms.
• We can usually answer questions about court
deadlines.
• We cannot give you legal advice. Only your
lawyer can give you legal advice.
• We cannot tell you whether or not you should
bring your case to court.
• We cannot give you an opinion about what will
happen if you bring your case to court.
• We cannot recommend a lawyer, but we can
provide you with the telephone number of a
local lawyer referral service.
• We cannot talk to the judge for you about what
will happen in your case.
• We cannot let you talk to the judge outside of
court.
• We cannot change an order issued by a judge.
Keep Copies of All Papers
Make and keep copies of all completed forms and
documents related to your case.
Name Change - Adult
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 3 of 15
Overview
The following is a brief overview of the process for having your name changed by a court. The details follow.
There are three basic steps that you must take to have your name changed by the court:
1. You must fill out forms to send to the court with a filing fee. (If you are changing the names of multiple
family members, there is only one fee.) The forms are contained in this packet and include a Verified
Complaint, a Certification of Confidential Information for Name Change, an Order Fixing Date of Hearing,
a Final Judgment, Final Judgment Addendum and a Case Information Statement.
2. When the court returns the Verified Complaint, Certification of Confidential Information for Name Change
and the Order Fixing Date of Hearing to you, the forms will contain a docket number and will tell you in
what newspaper you must publish the date of hearing. You must contact the newspaper to have the Order
Fixing Date of Hearing published at least two weeks before the hearing date, and you must notify other
interested parties. You must also send the Order Fixing Date of Hearing to the Director of the Division of
Criminal Justice via certified and regular mail at least 20 days before the hearing. You will have to provide
the court with proof that the appropriate parties have been notified of your intent to change your name.
3. At the time of the hearing, you will have to present proof of your current name. After you appear in court at
the hearing, you will have to publish the Final Judgment in the newspaper. You will also have to send
copies of the certified Final Judgment, with the Final Judgment Addendum attached, to the Department of
Treasury and the Registrar of Vital Statistics. If you have a driver’s license, you will have to present a copy
of the certified Final Judgment in person to the Motor Vehicle Commission.
Definitions of Words Used in This Packet
Affidavit of Publication - An affidavit of publication is a sworn statement made by a newspaper stating that
the newspaper has published the information regarding your name change.
Certification - A certification is a written statement you make when you file your papers with the court in
which you state that all the information contained in the papers is true to the best of your knowledge.
Civil Case Information Statement (CIS) The CIS is a form that summarizes your case for the court. Court
rules require that a CIS be filed with a verified complaint. The pro se version of the CIS which is to be used
with this packet can be found on our Self-Help Resource Center.
Docket Number - A docket number is the number the court assigns to your case so that it may be identified
and located easily. Once you have a docket number, you must include it on all your communications with the
court.
File - To file means to give the appropriate forms and fee to the court to begin the court’s consideration of
your case.
Final Judgment - The final judgment is a document signed by the judge which orders the name to be
changed.
Order Fixing Date of Hearing - An order fixing the date of hearing is a signed paper from the judge
indicating the date when you must come to court on your case and stating the name of the newspaper in
which you will have to publish your hearing date.
Proof of Mailing - Proof of mailing is the green card you get back from the Post Office that proves that the
material you sent by certified mail, return receipt requested, was received by the person to whom you sent it.
Verified Complaint - A verified complaint is a document in which you tell the court the facts of your case
and state what relief you want the court to give you. You certify that the information is true to the best of
your knowledge.
Name Change – Adult
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 4 of 15
The numbered steps listed below tell you what forms you will need to fill out and what to do with them. Each
form should be typed or printed clearly on 8 ½ “x 11” white paper only. Forms may not be filed on a different
size or color paper.
Steps to Obtain a Court Order to Change Your Name
STEP 1: Fill out the Verified Complaint and
the Certification of Confidential Information
for Name Change (Forms A and A1)
The Verified Complaint (Form A) tells the court
what your name is, what you want to change it
to, and why you want it changed. If you have
ever been convicted of a crime, or if there are
charges pending against you, you must include
this information in your Verified Complaint.
You must sign the certification which states that
the information in the complaint is true to the
best of your knowledge. The Certification of
Confidential Information for Name Change
(Form A1), which contains confidential
information, such as your social security
number, must also be completed and signed.
STEP 2: Fill out the Order Fixing Date of
Hearing, Final Judgment and Final Judgment
Addendum (Forms B, C and C1)
Enter the information requested. Note that there
are places on the Order Fixing Date of Hearing,
Final Judgment and Final Judgment Addendum
that the court will complete.
STEP 3: Fill out the Civil Case Information
Statement (CIS) (Form F)
This form summarizes your case for the court.
The case type number for a name change is 151.
The pro se version of the CIS which is to be
used with this packet can be found on our Self-
Help Resource Center.
STEP 4: Make a check or money order
payable to Treasurer, State of New Jersey in
the amount of $250.00.
This is the fee for filing your papers.
Note: If you are changing the names of
multiple family members, the $250.00 fee
covers all name change applications.
However, if any family members are under
the age of 18, you must use the packet
entitled “How to Ask the Court to Change
a Name in the Chancery Division, Family
Part.”
STEP 5: Check your completed forms and
make copies.
Check your forms and make sure they are
complete. Remove all instruction sheets. Make
sure you have signed all the forms wherever
necessary. You also need to make two copies of
each form. One copy will be sent to the court;
the other is for your records.
Checklist - In Step 6 you will be directed to
mail your documents to the court. The
following checklist will help insure your
package is complete:
The original of each of the forms you
filled out: Verified Complaint (Form A),
Certification of Confidential Information
for Name Change (Form A1), Order
Fixing Date of Hearing (Form B), Final
Judgment (Form C), Final Judgment
Addendum (Form C1) and the Civil Case
Information Statement (Form F)
One copy of each of these forms:
Verified Complaint, Certification of
Confidential Information for Name
Change, Order Fixing Date of Hearing,
Final Judgment, Final Judgment
Addendum and the Civil Case
Information Statement.
The filing fee in the amount of $250. It
must be a check or money order payable
to the Treasurer, State of New Jersey.
A stamped envelope addressed to
yourself so that the court will be able to
return the forms to you. Be sure to
include adequate postage.
Name Change – Adult
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 5 of 15
STEP 6: Mail or deliver the forms to the
court.
You may mail or deliver to the court the original
and one copy of all the forms: Verified
Complaint (Form A), Certification of
Confidential Information for Name Change
(Form A1), Order Fixing Date of Hearing (Form
B), Final Judgment (Form C), Final Judgment
Addendum (Form C1) and the Civil Case
Information Statement (Form F) along with a
self-addressed stamped envelope and the filing
fee. The court address can be found on the
Judiciary’s website, njcourts.gov. If you mail
the papers, we recommend that you use
certified mail, return receipt requested.
STEP 7: Review copies returned from
court.
The court will return copies of the Verified
Complaint, Certification of Confidential
Information for Name Change and Order Fixing
Date of Hearing to you. Once you receive them,
there will be a docket number written on all the
copies. The docket number is very important
because it identifies your case. It also lets the
court know how to find your case. You must
use the docket number on all future papers you
send to the court about your case. The court
will fill in the date on the Order Fixing Date of
Hearing. That is the day you will appear before
the judge to get the Final Judgment. The court
will also indicate the name of a newspaper in
which you are to have the notice of your hearing
date published.
IF YOU DO NOT HAVE PENDING CRIMINAL OR
DELINQUENT CHARGES IN NEW JERSEY, skip
to Step 9.
STEP 8: Notify the State or County
Prosecutor of your Application for a Name
Change.
If you have criminal charges pending against
you in New Jersey, you must send a copy of
the Verified Complaint, Certification of
Confidential Information for Name Change and
Order Fixing Date of Hearing by regular mail
and certified mail, return receipt requested to
the Prosecutor of the county where the matter
is being heard at least 20 days before the
hearing. If the charges were brought by the
Office of the Attorney General, you must send
a copy of the Verified Complaint, Certification
of Confidential Information for Name Change
and Order Fixing Date of Hearing to the
Director of the Division of Criminal Justice as
set forth in Step 9.
STEP 9: Notify the State of your
Application for a Name Change.
You must send a copy of the Order Fixing Date
of Hearing by regular mail and certified mail,
return receipt requested, to the Director of the
Division of Criminal Justice in Trenton, New
Jersey, at least 20 days before the hearing. Mail
a copy to:
Director, Division of Criminal Justice
ATTN: Records and Identification Section
R. J. Hughes Justice Complex
25 W. Market Street
P. O. Box 085
Trenton, NJ 08625-0085
Note: If you have criminal charges pending
against you in New Jersey, you must also
include a copy of the Verified Complaint and
Certification of Confidential Information for
Name Change.
STEP 10: Publish the Order Fixing Date of
Hearing.
In the Order Fixing Date of Hearing that you
receive back from the court, the judge will have
specified the name of a local newspaper. You
must have the Order Fixing Date of Hearing
published in the newspaper the judge chooses.
It must be published in the newspaper at least
two (2) weeks before the date of the hearing.
You should talk to the newspaper about how to
publish legal notices. Included in this packet as
Attachment E is a sample of the newspaper
notice.
STEP 11: Send Affidavit of Publication to the
court.
Once you have published the Order Fixing Date
of Hearing, the newspaper will send you an
Affidavit of Publication, which is proof that you
Name Change – Adult
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 6 of 15
had the newspaper publish the Order Fixing
Date of Hearing. You must send the original of
this Affidavit of Publication document to the
court immediately after you get it from the
newspaper. Keep a copy of it for your files.
STEP 12: Complete Proof of Mailing (Form
D) and send to court.
After you have mailed the required copies of the
Verified Complaint, Certification of
Confidential Information for Name Change
and/or signed Order Fixing Date for Hearing,
the post office will send you a green card (called
a certified mail receipt) for each recipient that
shows the mail was delivered. Once you get it
back, fill out the form called Proof of Mailing
(Form D) and check each entity to whom you
sent a copy of the Verified Complaint,
Certification of Confidential Information for
Name Change and/or the signed Order Fixing
Date of Hearing. Be sure to attach the original
green certified mail receipt(s) to the original
Proof of Mailing. Send the Proof of Mailing to
the court. Keep a copy of it for your files.
STEP 13: Appear in court on the date set by
the judge for your hearing.
Be sure to bring with you proof of your current
name.
STEP 14: Publish the Final Judgment in the
newspaper.
After the hearing, the court will record the
original Final Judgment signed by the judge as
well as the Final Judgment Addendum. As soon
as you receive your copy of the Final Judgment,
you must send it to be published in the
newspaper chosen by the judge (do not send a
copy of the Final Judgment Addendum to the
newspaper). The newspaper published version
of the Final Judgment shall not include your
social security number. The Final Judgment
must appear in the newspaper no more than 20
days after the date on the judgment. After you
have it published, the newspaper will send you
an original Affidavit of Publication.
STEP 15: Send the Affidavit of Publication to
the court.
As soon as you receive the Affidavit of
Publication from the newspaper, send the
original to the Court as proof that you had the
newspaper publish the Final Judgment. Keep a
copy for your records.
STEP 16: Order Certified Copies with a
Raised Seal of the Final Judgment with the
Final Judgment Addendum.
You will need a certified copy with a raised seal
of the Final Judgment, with the Final Judgment
Addendum attached, to be sent to both the
Department of Treasury (Step 17) and the
Registrar of Vital Statistics (Step 18). If you are
a licensed driver, a registered owner of a
vehicle, or possess a handicapped or non-driver
identification card, you must also present a
certified copy with a raised seal of the Final
Judgment, with the Final Judgment Addendum
attached, in person at any Motor Vehicle
Agency or Regional Service Center (Step 19).
The fee for each certified copy with a raised
seal is $25.00.
STEP 17: Send a copy of the certified Final
Judgment with the Final Judgment Addendum
to the Department of Treasury.
You must send a certified copy with a raised
seal of the Final Judgment, with the Final
Judgment Addendum attached, to the
Department of Treasury within 45 days after the
date of the Judgment. You must include a check
or money order payable to the Treasurer, State
of New Jersey in the amount of $50. Mail the
certified copy with a raised seal of the Final
Judgment, with the Final Judgment Addendum
attached, with the check or money order and a
stamped self-addressed envelope to:
Department of Treasury
Division of Revenue
Judgment Name Change Unit
P. O. Box 453
Trenton, NJ 08646
Name Change – Adult
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 7 of 15
STEP 18: Notify the Registrar of Vital
Statistics of the State.
You must send a certified copy with a raised
seal of the Final Judgment, with the Final
Judgment Addendum attached, to the Registrar
of Vital Statistics of the State in which you were
born. The Office of the Registrar is located in
the capital city of the State in which you were
born. Check to see if the office requires a fee.
If you were born in New Jersey, the address for
this office is:
Bureau of Vital Statistics
Attn: Vital Records Modifications Unit
P. O. Box 370
Trenton, NJ 08625
In New Jersey, there is a $2.00 fee to process
the legal name change. There is also a $25.00
fee if you want to receive a corrected birth
certificate, marriage license, civil union or
domestic partnership record. Checks or money
orders should be made payable to the Treasurer,
State of New Jersey. There is a $2.00 fee for
each additional copy of the same certificate.
STEP 19: Notify the Motor Vehicles
Commission.
If you are a licensed driver, a registered owner
of a vehicle, or possesses a handicapped or non-
driver identification card, you must present the
Final Judgment, with the Final Judgment
Addendum, in person at any Motor Vehicle
Agency or Regional Service Center within two
weeks after the effective date set forth in the
Final Judgment.
NOTE: The effective date is not the date of
the hearing or the date the Final Judgment
was signed. The effective date is the date you
may begin using your assumed name.
Additional information is available at njmvc.gov
regarding the list of acceptable documents to
satisfy the 6 points of identification.
Form A
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 8 of 15
Superior Court of New Jersey
Name
Law Division
County
Street Address
City, State, Zip
(To be filled in by the court)
Telephone Number
Civil Action
Verified Complaint Including
Certification of Plaintiff for Name
Change
In the Matter of the Application of:
Your Name
To Assume the Name of:
Name you wish to assume
The plaintiff, , whose place of residence is
(your name, first, middle, last)
, in the City of , County of
(street address) (City)
, in the State of New Jersey says:
(County
1. I am the Plaintiff in this matter.
2. My current legal name is
(your name, first, middle, last)
3.
My social security number can be found in the attached Certification of
Confidential Information for
Name Change.
4. I was born on .
(month, day, year)
5. I have since birth been identified by the following names: (first, middle, last)
6. I (check one) have have not been married.
7.
I (check one) have have never been convicted of a crime, and have no criminal charges
pending against me, except: (please supply county, municipality, nature, date of crime and/or pending charges)
8.
This application (check one) is is not being made with the intent to avoid creditors or criminal
prosecution or for other fraudulent purpose.
Save
Print
Clear
Form A
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 9 of 15
9.
I (check one) have have no unsatisfied judgments of record, or suits pending against me,
except: (enter any recorded judgments or pending suits)
10. I request this name change for the following reasons:
11. I (check one) have have not made any previous applications to assume another name.
12.
I (check one) do do not
have any pending applications for a name change in any other court or
jurisdiction to the best of my knowledge and belief, except: (enter the state, county and docket number(s) of
any pending applications)
13.
I understand that I must advise the court if there are any changes in the facts stated in this Verified
Complaint.
WHEREFORE, plaintiff demands judgment pursuant to N.J.S.A. 2A:52-1 to -4.
Signature of Plaintiff
Certification
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing
statements made by me are willfully false, I am subject to punishment.
Dated
Signature of Plaintiff
Form A1
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 10 of 15
Superior Court of New Jersey
Name
Law Division
County
Street Address
City, State, Zip
(To be filled in by the court)
Telephone Number
Civil Action
Certification of Confidential Information
for Name Change
In the Matter of the Application of:
Your Name
To Assume the Name of:
Name you wish to assume
In support of my application for a change of name, I, ,
(your name, first, middle, last)
state the following:
1. I am the Plaintiff in this matter and currently reside at ,
(street address)
in the City of , County of , in the State of New Jersey.
(City) (County)
2. My social security number is .
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing
statements made by me are willfully false, I am subject to punishment.
Dated
Signature of Plaintiff
Form B
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 11 of 15
Superior Court of New Jersey
Name
Law Division
County
Street Address
City, State, Zip
(To be filled in by the court)
Telephone Number
Civil Action
Order Fixing Date of Hearing
In the Matter of the Application of:
Your Name
To Assume the Name of:
Name you wish to assume
Application being made to the Court by ,
(your name, first, middle, last)
for a judgment authorizing (check one) him her to assume another name and for the entry of an
order fixing a date for the hearing of such application,
DO NOT WRITE BELOW THIS LINE THE COURT WILL COMPLETE
IT IS ON THIS day of , 20 , ORDERED that the day of
, 20 , at a.m., or as soon thereafter as the matter can be heard, at the c
ourthouse
in the City of
, County of , State of New Jersey, be fixed as the
time and place for the hearing of such application and of any objections that may be made thereto.
IT IS FURTHER ORDERED that a notice of such application be published in
once, at least two (2) weeks preceding the
date set for the
hearing.
J.S.C.
NOTE:
A copy of the Order Fixing Date of Hearing must be sent via regular mail and certified mail to
the newspaper for publication and served on the
Director of the Division of Criminal Justice. If there
are criminal charges pending, copies of the Verified Complaint, Certification of Confidential
Information for Name Change and Order Fixing Date of Hearing must be sent via regular mail and
certified mail and served on the
County Prosecutor and/or the Office of the Attorney General.
Form C
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 12 of 15
Superior Court Of New Jersey
Name
Law Division
County
Street Address
Docket No.
City, State, Zip
(To be filled in by the court)
Telephone Number
Civil Action
Final Judgment
In the Matter of the Application of:
Your Name
To Assume the Name of:
Name you wish to assume
, having made application to this Court by duly
(your name, first, middle, last)
verified complaint for a judgment authorizing (check one) him her to assume the name of
, and it appearing to the Court that all the provisions of
(name you wish to assume)
N.J.S.A. 2A:52-1-4 and the Current N.J. Court Rules relating thereto have been complied with:
IT IS ON THIS day of , 20 , ORDERED and ADJUDGED that
(leave blank for the court to complete)
, who was born on , and whose social
(your name, first, middle, last) (month, day, year)
security number is contained in the attached Final Judgment Addendum, be and hereby is authorized to
assume the name of , effective ,
(name you wish to assume) (leave blank for the court to complete)
(NOTE: This is the date you may begin using your assumed name), and
DO NOT WRITE BELOW THIS LINE THE COURT WILL COMPLETE
IT IS FURTHER ORDERED that within twenty days hereof, plaintiff shall cause a copy of only the
Final Judgment (not the Final Judgment Addendum) to be published once in
and within forty-five days after entry of Judgment, plaintiff shall file proof of
publication of this Final Judgment with the deputy clerk of the Superior Court (in the county in which you filed
your Verified Complaint
);
IT IS FURTHER ORDERED that the published version of the Final Judgment shall not contain the
social secur
ity number of the person whose name was changed; and
IT IS FURTHER ORDERED that within forty-five days after entry of Judgment, a certified copy of
this Final Judgment, with the Final Judgment Addendum attached, must be sent to the Department of Treasury
p
ursuant to the provisions of the Statute and Rules in such case made and provided.
Dated
J.S.C.
Form C1
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 13 of 15
Final Judgment Addendum
Pursuant to the Final Judgment dated , ,
(leave blank for the court to complete) (your name, first, middle, last)
whose social security number is , is authorized to assume the name of
.
(name you wish to assume)
This Final Judgment Addendum shall not be published with the Final Judgment or made
public in any
form.
Form D
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 14 of 15
Superior Court of New Jersey
Name
Law Division
County
Street Address
City, State, Zip
(To be filled in by the court)
Telephone Number
Civil Action
Proof of Mailing
In the Matter of the Application of:
Your Name
To Assume the Name of:
Name you wish to assume
A.
Check the appropriate box(es), below:
On , I, the undersigned, mailed a copy of the Order Fixing Date of Hearing in
accordance with the
Rules of Court to the Division of Criminal Justice of New Jersey, via
certified mail, return receipt requested.
OR
On , I, the undersigned, mailed a copy of the Verified Complaint for Change of
Name, Certification of Confidential Information for Name Change and Order Fixing Date of
Hearing in accordance with the
Rules of Court to (check all that apply):
the Division of Criminal Justice of New Jersey, via certified mail, return receipt
requested;
the Prosecutor of County, via regular mail and certified mail, return
receipt requested.
B.
Attached are the green return mail receipt(s) for (check all that apply):
the Division of Criminal Justice of New Jersey
the Prosecutor of County
I certify that the foregoing statements made by me are true. I am aware that if any of the
foregoing statements made by me are willfully false, I am subject to punishment.
Dated
Signature
Attachment E
Revised Form Promulgated by AJ Memo (11/01/2019), CN 10551 page 15 of 15
Sample Newspaper Notice
In the Matter of the Application of:
Your Name (first, middle, last)
To Assume the Name of:
Name you wish to assume
To Whom it May Concern,
Take notice that the undersigned will apply to County Superior Court
(county where the name change action is filed)
on the day of , 20 , at 9 o’clock in the morning at the courthouse
in the city of , New Jersey, for a judgment
(name of city)
authorizing , to assume the name of
(your name, first, middle, last)
.
(name you wish to assume, first, middle, last)
Your name
Street address
City, State, Zip
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- Adult (NJ Judiciary)

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Completed 21 July 2020

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