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Kentucky Name Change Petition Form

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

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AOC-295	 Doc.	Code:	PNC	
Rev.	10-08	
Page	1	of	1	
Commonwealth	of	Kentucky
Court	of	Justice	
www.courts.ky.gov
KRS	Chapter	401		PETITION FOR NAME CHANGE	
Case	No.			 	 		
Court			 	 	 		
County				 	 		
IN RE:  CHANGE OF NAME FOR 	_____________________________________________________________________	
COME(S) THE PETITIONER(S)	,	(choose one	):		
			__________________________________________		and 	_____________________________________________,	
	 living	parents	of	the	above-captioned	minor	(minor	refers	to	child	under	age	18,	see	KRS	401.020);	 or			
			____________________________________________________,	surviving	parent	of	above-captioned	minor;		or	
			_________________________________________________________,	guardian	of	above-captioned	minor;		or	
			above-captioned	adult,		AND IN SUPPORT OF THIS PETITION STATE(S)	:		
1.	 The	original	name	is		 	 	 	 	 	 	 	 	 	 	 	 		.	
2.	 The	desired	name	change	is		 	 	 	 	 	 	 	 	 	 	 		.	
3.	 Birthdate	(MM/DD/YY)	of	minor/adult	is		 	 	 	 	 	 	 	 	 		.		
4.	 Birth	location	(city,	county,	state)	of	minor/adult	is:			 	 		,	 	 		,	 	 		.	
5.	 Minor/Adult	currently	resides	in	the	county	in	which	this	Petition	is	filed.		His/Her	address	is:
			 	 	 	 	 	 	 	 	 	 	 	 	 	 		
			 	 	 	 	 	 	 	 	 	 	 	 	 	 		
6.	 Purpose	of	desired	name	change	is:			 	 	 	 	 	 	 	 	 	 		
			 	 	 	 	 	 	 	 		.		I	understand	identity	theft	is	a	Class	D	Felony	
	 in	Kentucky.	KRS	514.160.		I am not requesting this name change to avoid a legal obligation or evade prosecution.	
7.		For petition of minor with two living parents	:		Per	KRS	401.020,	if	a	parent	refuses	or	is	unavailable	to	execute	this		
	 Petition,		proper notice		of	its	filing		shall be made on absent parent		pursuant	to	the	Rules	of	Civil	Procedure.		
		Father	:		 	 	 	 	 	 	 	 	 	 	 	 	 				
	 Address:			 	 	 	 	 	 	 	 	 	 	 	 	 		
			 	 	 	 	 	 	 	 	 	 	 	 	 	 			
		Mother	:		 	 	 	 	 	 	 	 	 	 	 	 	 				
	 Address:			 	 	 	 	 	 	 	 	 	 	 	 	 		
			 	 	 	 	 	 	 	 	 	 	 	 	 	 		
WHEREFORE	,	Petitioner(s)	pray(s)	for	an	Order	for	Change	of	Name.	
Dated:	       	, 2	   	.	
Petitioner’s Signature 	        	 	Petitioner’s Signature 	        	
Attorney Name: 	             	
HEARING
Schedule	hearing	for			 		 		,	2		 		
at					 		a.m.			p.m.	
			 	 	 	
Judge	
Subscribed	and	sworn	to	before	me	on	
	 	 		,	2			.	
My	commission	expires:			 	 	 		,	2			.	
		 	 	 	 	
Notary			
Note:		File	this	Petition	in	the	Circuit	Clerk’s	Office	in	the	county	in	where	you	reside.	
Distribution for Hearing Notice:		Petitioner(s)	OR	Attorney	for	Petitioner(s),	if	any
Next: Kansas Order Changing Name Form Previous: King County Washington Minor Name Change Petition Form
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