New Jersey Name Change Kit Form
The New Jersey Name Change Kit is a kit that has all the form necessary for receiving a court-ordered name change in the State of New Jersey.
DownloadExtracted Text for Proper Search
FORM A
SUPERIOR COURT OF NEW JERSEY LAW DIVISION
County
Your Name (first, middle, last)
Docket Number
(to be filled in by the court)
Street Address
Town, State, Zip Code
Telephone Number
In the Matter of the Application of
Your Name (first, middle, last)
To Assume the Name of
Name You Wish To Assume (first, middle, last)
CIVIL ACTION
Verified Complaint
Including Certification of Plaintiff
for Name Change
The plaintiff, ,
whose place of residence is
(your name, first, middle, last)
, in the City of
(street address)
County of , in the State of New Jersey, says:
1. I am the Plaintiff in this matter.
2. I am (check one) am
□ am not □ a citizen of the United States of America.
3. My social security number is - - .
4. I was born on , in .
(month, day, year) (place of birth)
5. I am the (check one) son □ daughter □ of and
.
6. I was raised by
and
Revised 10/2011, CN 10551-English \050How to Ask the Court to Change your Name - Adult\051
Page 8 of 16
FORM A
7. I have since birth been ident ified by the following names:
..
(first, middle, last)
8. I (check one) have □ have never □ been married.
9. I have no unsatisfied judgments of record , or suits pending against me, except:
(enter any recorded judgments or pending suits)
10. I have never been convicted of a crime, and have no criminal charges pending against me,
except:
(please supply county, municipality, nature, date of crime and/or pending charges)
11. This application is not being made with the intent to avoid creditor s or criminal prosecut ion or for
other fraudulent purpose.
12. I (check one) have □ have not □ made any previous applications to assume another name.
13. I desire to assume the name of: .
(first, middle, last)
14. I request this name change for the following reasons:
Revised 10/2011, CN 10551-English \050How to Ask the Court to Change your Name - Adult\051
Page 9 of 16
FORM A
WHEREFORE,
plaintiff demands judgment pursuant to N.J.S.A . 2A:52-1 to -4.
Signature of Plaintiff
Certification
I certify that the foregoing statement s are true. I am aware that if any of the foregoing statements
made by me are wilfully false, I am subject to punishment.
Signature of
Plaintiff
Dated:
Revised 10/2011, CN 10551-English \050How to Ask the Court to Change your Name - Adult\051
Page 10 of 16
SUPERIOR COURT OF NEW JERSEYLAW DIVISION
County
Your Name (first, middle, last)
Street Address (to be filled in by the court)
Docket Number
Town, State, Zip Code
Telephone Number
In the Matter of the Application of
Your Name (first, middle, last)
To Assume the Name of
Name You Wish To Assume (first, middle, last)
CIVIL ACTION
Order Fixing Date
Of Hearing
Application being made to the Court by
,
(your name, first, middle, last)
for a judgment authorizing (check one) □ his □ her to assume another name and for
the entry of an order fixing a date fo r the hearing of such application,
DO NOT WRITE BELOW; THE COURT WILL FILL IN THE INFORMATION
IT IS ON THIS
day of , 20 , ORDERED that
the
day of , 20 , at
a.m., or as soon thereafter as the matter can be heard, at the Court House in the City
of
, County of , State of New Jersey, be
fixed as the time and place for the hearing of such application and of any objections
that may be made thereto.
Revised 10/2011, CN 10551-English \050How to Ask the Court to Change your Name - Adult\051
Page 11 of 16
IT IS FURTHER ORDERED that a notice of such application be published in
once, at least two (2) weeks preceding
the date set for the hearing.
,
J.S.C.
NOTE: Copies of the verified complaint a nd order fixing the date of the hearing
must be sent to the newspaper for publication and served on the County
Prosecutor and/or the Office of the Attorney General if there are criminal
charges pending.
Revised 10/2011, CN 10551-English \050How to Ask the Court to Change your Name - Adult\051
Page 12 of 16
SUPERIOR COURT OF NEW JERSEYLAW DIVISION
County
Your Name (first, middle, last)
(to be filled in by the court)
Street Address
Docket Number
Town, State, Zip Code
Telephone Number
In the Matter of the Application of
Your Name (first, middle, last)
To Assume the Name of
Name You Wish To Assume (first, middle, last)
CIVIL ACTION
Final Judgment
, having made application to this Court
(your name, first, middle, last)
by duly verified complaint for a judgment authorizing (check one) □ him □ her to
assume the name of
, and it appearing to
(name you wish to assume)
the Court that all the provisions of N.J.S.A . 2A:52-1-4 and the Current N.J. Court Rules
relating thereto have been complied with:
IT IS on this
day of ,20 ,
(leave date blank for court to complete)
ORDERED AND ADJUDGED that
, who
(your name)
was born on , and whose social security number is - - ,
(month, day, year ) (your social security number)
be and hereby is authorized to assume the name of from
(name you wish to assume)
and after ; and
(leave date blank for court to complete)
Revised 10/2011, CN 10551-English \050How to Ask the Court to Change your Name - Adult\051
Page 13 of 16
DO NOT WRITE BELOW THIS LINE; THE COURT WILL COMPLETE.
IT IS FURTHER ORDERED that within twenty days hereof plaintiff shall cause a
copy of this Final Judgment to be published once in____________________________;
and within forty-five days after entry of Judgment, plaintiff shall file proof of publication
of this Final Judgment with the deputy Clerk of the Superio r Court (in which you filed
your verified complaint) and a certified copy of this Final Judgment with the Department
of Treasury pursuant to the provisions of t he Statute and Rules in such case made and
provided; and
IT IS FURTHER ORDERED that the published version of the final judgment shall
not contain the social security number of the person whose name was changed.
J.S.C.
Dated:
Revised 10/2011, CN 10551-English \050How to Ask the Court to Change your Name - Adult\051
Page 14 of 16
SUPERIOR COURT OF NEW JERSEYLAW DIVISION
County
Your Name (first, middle, last)
Docket Number
(to be filled in by the court)
Street Address
Town, State, Zip Code
Telephone Number
In the
Matter of the Application of
Your Name (first, middle, last)
To Assume the Name of
Name You Wish To Assume (first, middle, last)
CIVIL ACTION
Proof of Mailing
On
, I, the undersigned, mailed a copy of the Complaint for
Change of Name and Order Fixing Date of H earing in accordance with the rules of Civil
Practice and Procedure, by certified United States Mail, return receipt requested to
(check and complete all that apply):
__ the Division of Criminal Justice of New Jersey
__ the Prosecutor of
County
NOTE: The green return mail receipt(s) are attached.
I certify that the foregoing stat ements made by me are true. I am aware that if any of
the foregoing statements made by me are wilf ully false, I am subject to punishment.
Your Signature
Dated:
Revised 10/2011, CN 10551-English \050How to Ask the Court to Change your Name - Adult\051
Page 15 of 16
SAMPLE NEWSAPER NOTICE
IN THE MATTER OF THE APPLICATION OF
\
Your name (first, middle, last)
TO ASSUME THE NAME OF
\
Name you wish to assume (first, middle, last)
TO WHOM IT MAY CONCERN:
Take notice that the undersigne d will apply to
(county where name change action is filed)
County Superior Court on the day of 20 , at
9 o’clock in the morning, at th e Court House in the City of ,
\
(name of city)
New Jersey, for a judgment authorizing __________________________ to assume the
(your name, first middle, last)
name of _________________________________________________.
(your name to assume, first, middle, last)
Your Name (first, middle, last) Street Address
Town, State, Zip Code
Revised 10/2011, CN 10551-English \050How to Ask the Court to Change your Name - Adult\051
Page 16 of 16
If you want to remove New Jersey Name Change Kit Form from this website please contact us providing the reasons together with this url: https://formsarchive.com/new-jersey-name-change-kit-form/