Louisiana Name Change Petition Form

In the case of applying for a name change in the State of Louisianna, the following form has to be completed and submitted.

Extracted Text for Proper Search

STATE OF LOUISIANA 
24th
 Judicial District Court for the Parish of Jefferson 
 
No.:  _________________                                                          Division:  “_______” 
 
 
________________________________________________________ 
 
vs. 
 
PAUL D. CONNICK, JR., DISTRICT ATTORNEY 
  
PETITION FOR NAME CHANGE 
  
I. 
 Petitioner, _________________________________________________________, born on 
__________________________, _________, with social security number _____________________, 
and domiciled in Jefferson Parish, Louisiana, wants to change his (her) name to 
_____________________________________________ for the following reason(s): 
II. 
[State reason(s) for name change here.] 
 
 
 
III. 
This proceeding is brought under LSA—R.S. 13:14751-13:4755, and it is thus mandatory 
that the district attorney of this parish be served with a copy of this petition and be cited to 
answer it. 
WHEREFORE, petitioner prays for judgment changing his (here) name from 
_________________________________________ to ________________________________________. 
 
RESPECTFULLY SUBMITTED: 
Indicate attorney’s name, address,    _____________________________________ 
phone number and bar number     Signature 
OR          
If petitioner is representing himself,    _____________________________________ 
indicate petitioner’s name, address,    Printed Name 
and telephone number. 
        _____________________________________ 
        Address 
PLAINTIFF TO MAKE HAND-DELIVERY 
SERVICE TO DISTRICT ATTORNEY:   _____________________________________ 
The Hon. Paul D. Connick, Jr.    City/State/ZIP Code 
District Attorney, 24th
 Judicial District Court   
200 Derbigny St.      _____________________________________ 
Gretna LA 70053      Telephone Number

STATE OF LOUISIANA 
24th
 Judicial District Court for the Parish of Jefferson 
 
No.:  _________________                                         Division:  “_______” 
 
 
___________________________________________________ 
 
vs. 
 
PAUL D. CONNICK, JR., DISTRICT ATTORNEY 
  
JUDGMENT 
 
 The Court, having considered the Petition for Name Change, together with the answer 
filed by the District Attorney for the 24th
 Judicial District Court in and for the Parish of Jefferson, 
State of Louisiana, and for the reasons assigned this date: 
 IT IS ORDERED, ADJUDGED AND DECREED, that there is judgment herein, granting 
the Petition for Name change, and changing the legal name of 
___________________________________________ to ______________________________________, 
pursuant to the provisions of Louisiana Revised Statute 13:4751, et seq. 
JUDGMENT READ, RENDERED, AND SIGNED AT GRETNA, LOUISIANA, this 
__________ day of the month of _____________________________, 20 ___. 
 
_______________________________________________________ 
JUDGE, 24TH
 JUDICIAL DISTRICT COURT