Missouri Name Change Judgment Form

In the State of Missouri, a name change doesn’t become final unless a judge signs and authorizes the Missouri Name Change Judgment Form.

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Approved for Use in Uncontested Cases Only  Change of Name Judgment – Page 1 of 2 Form CAFC470-07/01/2012                     This form is available for free at www.selfrepresent.mo.gov                                         IN THE CIRCUIT COURT OF _________________________, MISSOURI  ______________________________________________________ ______________________________________________________   Case No. ____________ ______________________________________________________  Division No. ____________ Petitioner(s),  Change of Name Judgment Parties 1. Appearances (Check all that apply)  Petitioner(s) appears in person.  Petitioner(s) appears by attorney.   Petitioner(s) appear by Next Friend.  ________________ appears in person.  ________________ appears by attorney.   2. The court finds that the change of name(s) would be proper and would not be detrimental to the interests of any other person.  3.  The name(s) of Petitioner(s) is/are changed as follows:  From To Birth Date                    Change of Birth Records 4.   It is further ordered that the Division of Health and Senior Services, Bureau of Vital Statistics for the State of Missouri alter the birth certificate(s) of Petitioner(s) to reflect this judgment.  This judgment shall be mailed by the Petitioner(s) to the Division of Health and Senior Services     It is further ordered that the State of ________________ alter the birth certificates(s) of Petitioner(s) to reflect this judgment.  This judgment shall be mailed by the Petitioner(s) to the appropriate state of birth of Petitioner(s).  Notice 5.    Notice of the change of name(s) shall be published at least once each week for three consecutive weeks in the following newspaper of general circulation:  ________________________________________________________________________________    No notice of change of name is to be published because the petitioner is the victim of a crime based upon domestic violence as defined in §455.200, RSMo; or the victim of child abuse as defined in §210.110, RSMo; or the victim of abuse by a family or household member, as defined in §455.010, RSMo.

Change of Name Judgment – Page 2 of 2 Form CAFC470-07/01/2012                     This form is available for free at www.selfrepresent.mo.gov                          Court Costs 6.   Court costs are to be paid from the court cost deposit(s) previously posted.    Court costs are waived.  Waiver of Right to Rehearing (If case is heard by a Commissioner pursuant to §487.010, RSMo et seq.)   We, the undersigned parties, do hereby acknowledge receipt of the findings and recommendations of the commissioner and waive the right to file a motion for rehearing in this case.   (If heard by a Family Court Judge)   __________________________ ___________ Judge    Date  (If heard by a Family Court Commissioner) Findings and Recommendations of Commissioner:  __________________________ ___________ Commissioner   Date  All orders and these findings and recommendations of the Commissioner are confirmed and adopted as the judgment of the court.  __________________________ ___________ Judge    Date   A certified copy of this judgment is to be mailed to the following person(s):  (Check all applicable boxes)    Petitioner’s Attorney  ____________________________ (Signature of Attorney) ____________________________ (Street) ____________ ______  ______ (City)  (State) (Zip) _________________________ (Telephone Number)      Petitioner  ____________________________ (Signature of Petitioner) ____________________________ (Street) ____________ ______  ______ (City)  (State) (Zip) _________________________ (Telephone Number)     Petitioner  ____________________________ (Signature of Petitioner) ____________________________ (Street) ____________ ______  ______ (City)  (State) (Zip) _________________________ (Telephone Number)