IN THE CHANCERY COURT FOR _____________ COUNTY, TENNESSEE
PETITION FOR CHANGE OF NAME
IN RE:
___________________________________________ Docket No. _________________
Petitioner
(Print or Type)
C
omes now the petitioner requesting change of name and makes oath and/or affirmation that the following facts are correct and
complete:
1.
My full name is ______________________________________________________________. I am a resident of
(Current Legal Name)
_______________________ County, Tennessee, residing at ____________________________________________________.
I
am a citizen of _____________________________.
2
. I am more than 18 years of age. I was born on ____________________________________ in
___________________________
, in ________________________ County. The name given to me at birth was
(City)
__________________________________________________________ as reflected on my birth certificate issued by the State of
_____________________________________
.
3
. All other names and aliases by which I have been identified since birth are (state in chronological order and attach a copy
of a court order or other document for all legal name changes):
__________________________________________________________________________________________________
_____
_______________________________________________________________________________________________________.
4. I desire to change my name from ________________________________ to ________________________________.
5. The reasons for the name change ar
e:
_______________________________________________________________________________________________________
.
6. The change of my name will not adversely affect the rights of any minor children nor require that their names be changed.
I am not seeking this change of name to evade the claims of my creditors, to evade legal process, nor for any other unlawful purpose.
7. a) Have you been convicted of a felony? Yes G No
If you answer “Yes” to question 7a, complete question 7b.
b) I have been convicted of the felony of ________________________________________________.
8. In support of this Petition, I attach copies of my birth certificate, photo identification (such as a driver=s license, passport or
comparable photo identification), and social security card.
I
swear or affirm that I have read the Petition and the facts are correct and complete.
Petitioner: ___________________________________________
Daytime phone number: ________________________________
Email address: _______________________________________
Sworn to and subscribed before me this _____ day of ______________
___, 20_____.
____________________________________
Notary Public
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