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FORM 12.982(a): PETITION FOR CHANGE OF NAME (ADULT) (Florida)

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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.982(a)
PETITION FOR CHANGE OF NAME (ADULT)
(02/18)
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 dissolution of marriage or for adoption of child(ren). If you want a change
of name because of a dissolution of marriage or adoption of child(ren) that is not yet final, the change
of name should be requested as part of that case.
This form should be typed or printed in black ink and must be signed 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?
Unless you are seeking to restore a former name, you must have fingerprints submitted for a state and
national criminal records check. The fingerprints must be taken in a manner approved by the Department
of Law Enforcement and must be submitted to the Department for a state and national criminal records
check. You may not request a hearing on the petition until the clerk of court has received the results of
your criminal history records check. The clerk of court can instruct you on the process for having the
fingerprints taken and submitted, including information on law enforcement agencies or service providers
authorized to submit fingerprints electronically to the Department of Law Enforcement. The process may
take several weeks and you will have to pay for the cost of processing the fingerprints and conducting the
state and national criminal history records check. Please note that the state and national criminal
records check must indicate whether you have registered as a sexual predator or a sexual offender and
you must also indicate on this petition whether you have ever been required to register as a sexual
predator under section 775.21, Florida Statutes, or as a sexual offender under section 943.0435, F.S.
Next, you must obtain a hearing date for the court to consider your request. If you are seeking to restore
a former name, a hearing on the petition MAY be held immediately after the petition is filed. The final
hearing on any other petition for a name change may be held immediately after the clerk of court receives
the results of your criminal history records check. 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), Florida Supreme
Court Approved Family Law Form 12.982(b), which the judge may use. You should contact 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
Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult)
(02/18)
copies, and the clerk can tell you the amount of the charges.
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.
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration ow require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.
IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION
After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida
Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the
Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court
in the A-Z Topical Index.
SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.
To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.
Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult)
(02/18)
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, 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
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)
(02/18)
_________________________________________________________________________________
IN THE CIRCUIT COURT OF THE ____________JUDICIAL CIRCUIT,
IN AND FOR______________________COUNTY, FLORIDA
IN RE: THE NAME CHANGE OF
Case No.: ________________________
Division: _________________________
_______________________________,
Petitioner.
PETITION FOR CHANGE OF NAME (ADULT)
I, {full legal name} _________________________________, being sworn, certify that the following
information is true:
1. My complete present name is: _______________________________________________________
I request that my name be changed to: ________________________________________________
2. I live in _________________ County, Florida, at {street address} _____________________________
3. I was born on {date}______________, in {city} _________________________, {county} __________,
{state} ______________________, {country} _________________.
4. My parents’ full legal names are :
a. ___________________________________________
b. _______________________________
c. {If applicable }My parents’ maiden name(s) is/are: ____________________________
and __________________________________________________________________
5. I have lived in the following places since birth:
Dates (to/from) Address
_______/_________ ____________________________________________________
_______/_________ ____________________________________________________
_______/_________ ____________________________________________________
_______/_________ ____________________________________________________
(___ Please indicate here if you are continuing these facts on an attached page.)
6. Family
[Indicate all that apply]
a._____ I am not married.
Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (02/18)
_______________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
__________________________________________________________________________
b._____ I am married. My spouse’s full legal name is: _____________________________
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
(______Please indicate here if you are continuing these facts on an attached page.)
7. Former names
[Indicate all that apply]
a. _____ My name has never been changed by a court.
b. _____ 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.
c. _____My name previously was changed by marriage from__________________________
to ___________________ on {date} ,
in {city, county, and state_______________________________________________________.
A copy of the marriage certificate is attached.
d. _____I have never been known or called by any other name.
e. _____ 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
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (02/18)
_________ _____________ __________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
(_______Please indicate here if you are continuing these facts on an attached page.)
9. Business [Choose 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: .
I have been involved with the business since: {date} .
10. Profession
[Choose 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
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
( _____ Please indicate 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
_________ _____________ __________________________________________________
_________ _____________ __________________________________________________
(________ Please indicate here if you are continuing these facts on an attached page.)
12. Criminal History
Indicate all that apply
_ 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:
Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (02/18)
Date City/State Event (arrest, charge, plea, or adjudication)
( _______ Please indicate here if you are continuing these facts on an attached page.)
I _____ have____have not ever been required to register as a sexual predator under section 775.21,
Florida Statutes.
I _____ have ______have not ever been required to register as a sexual offender under section
943.0435, Florida Statutes.
13. Bankruptcy
[Choose one only]
_I have never been adjudicated bankrupt.
_I was adjudicated bankrupt on {date} , in {city} ,
{county} , {state} .
(______ Please indicate here if you have filed additional bankruptcies, and explain on an attached
page.)
14. Creditor(s)’ Judgments
[Choose 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 {date}
______ _________ _________ _______________________________________________
______ _________ _________ _______________________________________________
______ _________ _________ _______________________________________________
______ _________ _________ _______________________________________________
(_______ Please indicate here if these facts are continued on an attached page.)
15. Fingerprints and Criminal History Records Check
Unless I am seeking to restore a former name, a copy of my fingerprints has been taken in a manner
approved by the Department of Law Enforcement and submitted for a state and national criminal
history records check. I understand that I cannot request a hearing on my Petition until the Clerk of
Court receives the results of the criminal history records check. I also understand that the state and
national records check must indicate whether I have registered as either a sexual predator or sexual
offender.
16. 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.
Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (02/18)
_____________________________________________
_____________________________________________
_____________________________________________
17. My civil rights have never been suspended, or, if my civil rights have been suspended, they have been
fully restored.
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: ______________________
STATE OF FLORIDA
COUNTY OF ____________________
Signature of PETITIONER
Printed Name: _________________________________
Address: _____________________________________
City, State, Zip: ________________________________
Telephone Number: _____________________________
Fax Number: __________________________________
Designated E-Mail Address(es):____________________
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 ________________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared by the Petitioner.
This form was completed with the assistance of:_____________________________________________
{name of individual} ___________________________________________________________________,
{name of business}:____________________________________________________________________,
{address} ____________________________________________________________________________,
{city} ________________, {state}_____,{zip code}________,{telephone number} __________________.
Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (02/18)
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FORM 12.982(a): PETITION FOR CHANGE OF NAME (ADULT) (Florida)

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Completed 2 September 2020

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