New Hampshire Name Change Petition Form

The New Hamshire Name Change Petition is a form that has to be submitted to the court clerk’s office for starting the legal process of a name change.

Extracted Text for Proper Search

NHJB-2175-P (12/04/2009) Page 1 of 2 
(formerly AOC-087-003) 	
 
 	THE STATE OF NEW HAMPSHIRE	 	
JUDICIAL BRANCH 
http://www.courts.state.nh.us	 	
 	
Court Name: 
Case Name: 
Case Number: 
  (if known)  	
 
Name change of   
 	
PETITION FOR CHANGE OF NAME 
FOR 	
  ADULT  	  MINOR 
 	
 1.  Petitioner Name   	 Telephone  	 
  Mailing Address   
 
  Petitioner Name   	
 Telephone  	 
  Mailing Address   
 
 2.  Minor Name   	
 Telephone  	 
  Mailing Address   
 
  Relationship of petitioner to minor  
 
 3.  Attorney Name   	
 Telephone  	 
  Mailing Address   	
 Bar ID#  	 
 4.  Are there any pending guardianship, juvenile,  domestic violence, marriage dissolution, domestic 
relations, paternity, legitimization, custody or other proceedings  affecting this child or the 
proposed adoptive parents  of this child?  	
  Yes  	  No          If yes, attach a separate sheet 
identifying and explaining each. 
 
Please complete the following information as it applies to the person whose name is being 
changed. 	
 
 5.  Town of residence  	
 
 6.  Date of birth  	
  Place of birth   	 
 7.  If minor, name  of mother  
 
  Mailing Address   
 
 8.  If minor, name  of father  
 
  Mailing Address

Case Name: Name change of  	 
Case Number:  
 
PETITION FOR CHANGE OF NAME	
 	 	
NHJB-2175-P (12/04/2009)  Page 2 of 2 
(formerly AOC-087-003) 
 9.  Check the following paragr aphs that apply to the person whose name is being changed.   
 	
  I am a person who is serving a prison sentence, or who is on probation  or parole.  I certify 
that I have had the sheriff’s department serve a  copy of this petition on the department of 
corrections.  I understand that failure to comp ly with notification requirements shall cause 
any order hereunder to be null and void. 
 
  I am a person who is required to register  as a sexual offender or an offender against 
children pursuant to RSA 651-B.  I certify th at I have had the sheriff’s department serve a 
copy of this petition on the department of safety  or other agency. I understand that failure to 
comply with notification require ments shall cause any order hereunder to be null and void. 
 
  Neither of the above paragraphs are applicable to this name change.   
 
The petitioner requests  that the name    	
 be changed 	 
    (First, middle and last names)	 
to          	
 in accordance with the  laws of the State of 	 
    (First, middle and last names)	 
New Hampshire and for the following reasons:   
                	
                	 
 
Except as noted in #9, I certify that I have provided  a copy of this document to the parties who have 
filed an appearance in this case or are otherwise interested parties. 
 
 	
  	 	
Date  Petitioner Signature  
 	  	 	
Date Petitioner Signature  
 
 
PLEASE NOTE:  If this name change is for a minor, a certified copy of the minor’s birth certificate 
must accompany this petition.  If this name c hange is for an adult, proof of identity must accompany 
this petition. 
 
ORDER 
 
The above petitioner has sworn before the judge that the facts are true to his/her best knowledge and 
belief.  Accordingly, the court orders that: 
 	
 Petition is granted. 
 Petition is denied. 
 
      	
          	 	
Date         Judge