Hawaii Name Change Notice Form

In the case of a successful name change in the State of Hawaii, the new name has to be announced in a newspaper. Use the following form to submit your new name to the newspaper that will announce it.

Extracted Text for Proper Search

Form A - eff: 11/18/2010 Page 10	
 
 
Name:                                                       
Address:                                                       
City, State, Zip Code:  
Telephone #: 
________________________________________________________________________\
__________________ 
                                                                        \
                                           	
IN THE OFFICE OF THE LIEUTENANT GOVERNOR 
 
STATE OF HAWAII   
 
In the Matter of the Petition      )  ) 
of      ) 
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_________________________________ 
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For Change of Name         ) 
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___________________________________ 
 
 
 
NOTICE OF CHANGE OF NAME  
                                                             
Upon consideration of the Petition of  	
__________  
 
and there appearing to me to be good reasons for granting the same: 
  NOW, THEREFORE, by virtue of the authority vested in me by law and thereunto  
 
enabling, I, Brian E. Schatz, Lieutenant Governor of  the State of Hawaii, do hereby give public notice  
  shall be  
                                                                        \
                    
that the name of  	
__________    
  upon a single publication in  
                                                             
changed to  	
________________    
  , a newspaper of general circulation in the State of Hawaii, 
in the 	
Honolulu Star-Advertiser	
 
 published at Honolulu, Hawaii. 
 
  DATED:  Honolulu, Hawaii _________________                                       
                     
  
 
       _________________________________________  BRIAN E. SCHATZ      
       Lieutenant Governor of the State of Hawaii

Form A - eff: 11/18/2010 Page 11	
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I, Brian E. Schatz, Lieutenant Governor of the State  of Hawaii, by virtue of the authority vested in me

Form A - eff: 11/18/2010 Page 12	
 
 
 
by law and thereunto enabling, do hereby order that the name of ____________________________________ 
 
_______________________  be changed to _____________________________________________________ 
 
. 
effective                                         
 
 
Dated: Honolulu, Hawaii _____________________                        
         
  ______________________________________ 
BRIAN E. SCHATZ 
Lieutenant Governor of the State of Hawaii