VIRGINIA
IN THE CIRCUIT COURT OF ROCKINGHAM COUNTY
80 COURT SQUARE, HARRISONBURG, VA 22802
____________________________________________
COMPLAINANT
VS. CIVIL NO. ________________________
____________________________________________
DEFENDANT
ORDER FOR NAME CHANGE – DIVORCE
THIS DAY came your Complainant Defendant who makes application pursuant to
§§ 8.01-217 (C) and 20-121.4 of the Code of Virginia that she/he be restored to the use of
her/his former name, and
IT APPEARING TO THE COURT that the applicant’s name is
_____________________________________________________________________________________________;
First Name Middle Name Last Name Suffix
that she/he was divorced on ___________________; that she/he desires to be restored to the use
of her/his former name;
_____________________________________________________________________________________________;
First Name Middle Name Last Name Suffix
And that her/his current address is:
_____________________________________________________________________________________;
and it is therefore
ADJUDGED, ORDERED and DECREED that the name of
_____________________________________________________________________________________________;
First Name Middle Name Last Name Suffix
is hereby changed to
_____________________________________________________________________________________________.
First Name Middle Name Last Name Suffix
Pursuant to Va. Code §§ 8.01-581.1 through 581.20 this instrument shall be recorded and
indexed in the current deed book of this court.
ENTERED THIS _______ DAY OF _________________________, 20______.
_____________________________________________
JUDGE
I ask for this
Counsel for Complainant/Defendant
I hereby request this Change of My Name ______________________________________________
