KSJC 12/2010 Page 1 of 3
IN THE EIGHTEENTH JUDICIAL DISTRICT
DISTRICT COURT OF SEDGWICK COUNTY, KANSAS
Case No. _____________
Div. No. _____________
PURSUANT TO K.S.A. CHAPTER 60
ORDER CHANGING NAME
Pursuant to K.S.A. 60-1402
NOW, on this _____ day of _______________, 20_____, the above-captioned matter
comes before the Court upon the Petition of ________________________________, for change
of his/her name. Petitioner appears in person. There are no other appearances.
The Court, after review of the record of the proceedings herein, approves service or
waives any requirement for notice and determines the matter may proceed to hearing.
The Court, upon hearing the testimony, upon examining the evidence presented, and
upon review of the record of the proceedings herein, finds as follows:
1. The Court has jurisdiction over the parties and the subject matter in this case.
2. Venue is appropriate in Sedgwick County, Kansas.
3. Service has been properly obtained on, or notice has been given to, all interested
parties, or service and notice have been waived because there are no interested parties other than
petitioner.
4. The allegations contained in Petitioner’s Petition are true.
IN THE MATTER OF THE PETITION OF
Present Name
To Change His/Her Name to:
New Name
KSJC 12/2010 Page 2 of 3
5. Petitioner, __________________________________, is now and has been a resident
of Kansas, for a period of more than sixty (60) days immediately preceding the filing of the
Petition.
6. Petitioner’s YEAR of birth is and petitioner’s place of birth is
____________________ County in the State of___________________________.
7. Petitioner’s birth certificate shows his/her name as ____________________________
_____________________________________________________________________________.
8. Petitioner’s present name is: ____________________________________________.
9. Petitioner seeks to change his/her name to __________________________________
because _______________________________________________________________________
_____________________________________________________________________________.
10. The Petition for Change of Name is not made for the purpose of avoiding any debts,
obligations or legal process nor is it made for the purpose of misleading or defrauding any
person. The requested name change will not result in prejudice to any person.
11. No objections have been made to the Court and the Court finds Petitioner is entitled
to have his/her name changed from ____________________________________ to:
__________________________________________________.
IT IS THEREFORE BY THE COURT CONSIDERED, ORDERED, ADJUDGED,
AND DECREED that the above and foregoing findings are made as orders of this Court, that
Petitioner’s name be changed to _______________________________________________, and
that the costs of this proceeding are assessed against Petitioner.
KSJC 12/2010 Page 3 of 3
IT IS FURTHER ORDERED that, upon proper application, an amended or substitute
birth certificate be issued to reflect Petitioner’s new name.
IT IS SO ORDERED this _____ day of ________________, 20____.
____________________________________
Judge of the District Court
SUBMITTED BY:
________________________________________
Petitioner, Pro Se
Name (Print):_____________________________
Address 1: _______________________________
Address 2: _______________________________
City, State, Zip: ___________________________
Telephone Number: ________________________
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