Hawaii Name Change Petition Form

In the case of wanting to petition a legal name change in the State of Hawaii, the following form has to be completed and submitted.

Extracted Text for Proper Search

Form A - eff: 11/18/2010 Page 6	
 
IN THE OFFICE OF THE LIEUTENANT GOVERNOR   
OF THE STATE OF HAWAII 
  In the Matter of the Petition      )  ) 
of     )  ) ) 
(1) __________________________________ 
) 
For Change of Name         ) 
)   
___________________________________ 
                                                      
  PETITION 
  TO THE HONORABLE BRIAN E. SCHATZ, LIEUTENANT GOVERNOR OF THE 
  STATE OF HAWAII: 
 
(2)    COMES NOW ______________________________________________________________  
   your petitioner herein, and respectfully pray that an order be entered h\
erein  
   name and in support thereof represents as follows: 
(3)  changing            
 
I. 
 
(4)    That your Petitioner’s date of birth is ____________________________________________ 
  place of birth is ____________________________________________________________________ 
 
father’s name is ____________________________________________________________________  (Name as shown on birth certificate) 
mother’s maiden name is ____________________________________________________________  (First)   (Middle)  (Surname)  
II. 
 
(5)    That the name on your Petitioner’s birth certificate or certificate of naturaliza\
tion is    
________________________________________________________________________\
_________ 
(First)     (Middle)    (Surname)

Form A - eff: 11/18/2010 Page 7	
 
III. 
 
(6)  That other names Petitioner is using or has used are as follows: 
  ________________________________________________________________________\
_____         
                                                                        \
                                           
IV. 
 
(7)  That your Petitioner is a re sident of the State of ________________________________________ 
  and Petitioner’s present address is ____________________________________________________ 	
(Residence address) 	
 _______________________________________________________________________\
__________ 
  V. 
 
(8)    That your Petitioner: 
   has not been convicted of a felony or a sexual offense. 
          
 
 has been convicted of a felony. 
          	
 
_____ has been convicted of a sexual offense 
      Date of Conviction	
 
   Disposition	Felony or Sexual Offense	
 
 
 
If Petitioner has been convicted of a felony or a sexual offense, respon\
d to the following questions: 
  1.  Fully explain the charges. 
 
  2.  Fully explain the sentence. 
 
  3.  Fully explain the terms and conditions of parole or probation. 
 
  4.  Fully explain the date of final discharge of the sentence. 
 
  5.  Fully explain whether there was a deferred acceptance of a guilty or no \
contest plea. 
 
  6.  Fully explain if there was a pardon, by whom the pardon was granted.

Form A - eff: 11/18/2010 Page 8	
VI. 
  That this Petition is not filed for the purpose of avoiding payment of debts to creditors; your 
   Petitioner has been and is a good law-abiding citizen and your Petitione\
r states that this Petition for 
   Change of Name is not for wrong or fraudulent purposes. 
  VII. 
  That your Petitioner is now requesting a Change of Name to 
  ________________________________________________________________________\
______
                                                                          \
                                                 (9) 
WHEREFORE, your Petitioner prays that an order be entered herein Changing \
Petitioner’s  
   to 
(10)  name from                                                                         \
                                         	
 
________________________________________________________________________\
_______   DATED: _____________________  ____________________Hawaii 	
(City) 	
 
(11)              _______________________________________              
Petitioner (Sign name in full) 
 
STATE OF HAWAII     ) 
) )  SS. 
_______________________ 
COUNTY OF 	
(Honolulu, Hawaii, Maui, Kauai) 	
 
, being first duly sworn on oath  
(12)    _________________________________________________ 	
(Name of Petitioner) 	
deposes and says: 
  That Petitioner is the person named herein, that Petitioner has read the foregoing Petition,  
  knows the contents thereof, and that the same is true to the best of the Petitioner’s knowledge. 
       ______________________________________  
(13) 
Petitioner (Sign name in full) 
 
Subscribed and sworn to before me  
  day of  20
_______________  ___        
                                                              
this            	
_____________________________________             
Notary Public, State of Hawaii 
My Commission expires:  ________________