Nebraska Name Change Petition Form

The Nebraska Name Change Petition is a form that is used for allowing a resident of the State of Nebraska to initiate a legal name change process in the State of Nebraska. The mentioned form has to be submitted to the county court clerk’s office where you reside.

Extracted Text for Proper Search

Petition for Name Change, DC 6:9(1) PSC, Rev. 12/11 
 	
1	
IN THE DISTRICT COURT OF ________________ COUNTY, NEBRASKA 	                  (county where Petition filed)	 
 
IN RE NAME CHANGE OF    ) CASE No.___________________ 
     )     
(case number assigned by Clerk of Court) 	
      ) 
_____________________.   )            PETITION FOR NAME CHANGE  	
(your full name)	    )  
 
 
      
I,  _________________________ ______, without the assistance of an attorney,  
                     	
(your full name) 
 	
ask this Court for a name change .  In support of my Petition, I state that the following  
 
 
items are true:   
    
  1.  My address is _______________ ______________________________,   
                                               	
(your present street address) 
 	
_____________________,   ____________________County,  Nebraska. 
         	   (city where you live)                 (county where you live) 	
 
   2.  I have been a resident of ______ ______________ County, Nebraska  
               	
(county where you live ) 	
 
for more than one year  prior to the filing of this petition.  
 
  3.  My date of birth is provided on  the Confidential Party Information  
 
Form (page 3 of the Peti tion for Name Change). 
 
  4.  My current name is  _________________________________.  
                     	
(your current full name) 	
 
5.  I desire the court to change my name of 
 
 ________________________________   to  ________________________________. 	
                (your current full name)                          (preferred new full name)

Petition for Name Change, DC 6:9(1) PSC, Rev. 12/11 
 	
2	
6.  I desire to change my name for the following reason(s): 
 
________________________ ______________________________________________ 	
            (list here why you desire to change your name) 
 
________________________ ______________________________________________  
 
________________________ _____________________________________________. 
 
  WHEREFORE, I respectfully request that  the court set this matter for hearing,  
 
and that upon such hearing, order  my name to be changed from   
 
________________________ _____ to __________________ __________________. 
             (current full name)             (preferred full name) 
                   
                                        
 
                       
       ______ __________________________ 
       	
Petitioner (print your current name) 	
 
       ______ __________________________ 
     	
  	Signature 	
             
       ______ __________________________ 
       	
Street address	 	
             
       ______ __________________________ 
       	
City, State, ZIP code	 	
           
       ______ __________________________ 
       	
Telephone number

Confidential Information Form, DC 6:9(1) PSC, Rev. 12/11 
(required form for Petition for Name Change) 
 	
3	
IN THE DISTRICT COURT OF ________________ COUNTY, NEBRASKA 	                  (county where Petition filed)	 
 
THIS DOCUMENT IS CONFIDENTI AL AND SHALL NOT BE MADE  
PART OF THE COURT FILE OR  PROVIDED TO THE PUBLIC 
PURSUANT TO NEB. CT. R.  § 6-1521. 
 
 
 
IN RE NAME CHANGE OF    ) CASE No.___________________ 
     )     
(case number assigned by Clerk of Court) 	
      ) 
_____________________.   )            CONFIDENTIAL PARTY  	
(your full name)	    )     INFORMATION FORM 
 
 
 
 
Name      Gender  Birth Date     
Petitioner: 
 
              	
(your current full name)