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.

Extracted Text for Proper Search

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