Petition For Change Of Name (Adult)

V I R G I N I A IN THE CIRCUI T COURT OF FAIRFAX COUNTY In the matter of the change of name of At Law ____________ to PETITION FOR CHANGE OF NAME COMES NOW the petitioner seeking a change of name pursuant to Virginia Code 8.01-217 and respectfully states under oath as follows: The petitioner currently resides in the County/City of . The petitioner desires a change of name for the following reasons: . This change of name is not sought for any fraudulent purpose and will not infringe on the rights of another. The name of the petitioner is . The current address of the petitioner, including street, city and state of residence is . The petitioners father is and the petitioners mother is , whose maiden name is . The petitioners date of birth is , and the place of birth of the petitioner is . The petitioner has no felony conviction record, and is not currently incarcerated or a probationer with any court. The petitioner has previously had a change of name or changes of name, as follows: . Signature of Petitioner Daytime Phone Number IN THE COMMONWEALTH OF VIRGINIA, COUNTY OF : I, the undersigned Deputy Clerk/ Notary Public in and for the State of Virginia, do hereby certify that before me appeared , whose name is signed to the foregoing Petition, and acknowledged the same under oath before me. Given under my hand and seal this day of , . ____________________________ Deputy Clerk/Notary Public My Commission Expires CCR A-160 7-8 July 2003 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 V I R G I N I A IN THE CIRCUI T COURT OF FAIRFAX COUNTY In the matter of the change of name of At Law _______________ to O R D E R This day came the petitioner, seeking to change their name. IT APPEARING to the Court that: The current address of the petitioner, including street, city and state of residence is ________________________________________________________________________ _____. The petitioner has previously had a change of name or changes of name, as follows: ADJUDGE D, ORDERED and DECRE ED that the name of the petitioner is hereby changed from to , and further ADJUDGE D, ORDERED, and DECREED that the Clerk of this Court, pursuant to the provisions of Virginia Code 8.01-217 shall spread this order upon the current deed book, index it in both the old and new names, and transmit a certified copy to both the State Registrar of Vital Statistics and the Criminal Records Exchange. Entered this day of , . JUDGE I ASK FOR THIS: _____________________________ ____________________________ Signature of Petitioner(s) CCR A-160 7-8 July 2003 American LegalNet, Inc. www.USCourtForms.com