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Virginia Minor Name Change Form

In Virginia, should a minor decide to apply for a name change, s/he is required to use this form. One of the parents must apply for the name change on behalf of the child while the other parent should express consent in writing.In Virginia, should a minor decide to apply for a name change, s/he is required to use this form. One of the parents must apply for the name change on behalf of the child while the other parent should express consent in writing.Download

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APPLICATION FOR CHANGE OF NAME (MINOR)  	Case No. 	.................................................	 	
Commonwealth of Virginia 	Va. Code § 8.01-217	 	
In the Circuit Court of the  [  ] City   [  ] County of 	........................................................................\
........................	 	
 
In re:  	........................................................................\
......................................................................................	 	 	(MINOR’S  NAME) FIRST   MIDDLE   LAST    SUFFIX 	
 
  COMES NOW, the applicant,  and
  after being duly sworn states under oath as follows: 
 
1.  Minor’s name is stated accurately above and  	
[  ] 	has 	 [  ] 	has not been previously changed. If so, court order is attached. 
 
2. Applicant’s Name: 	
........................................................................\
............................................................... 	 	 F IR ST    M ID DLE    L AST    S UFF IX	 
 
2a. Residence Address: 	
........................................................................\
......................................................... 	       STREET  ADDRESS   
........................................................................\
.......................................................................................... 
 	CITY    STATE   ZIP  CODE      COUNTRY     
 	
2b. Mailing Address: 	........................................................................\
............................................................	 	     	 	IF DIFFERENT FROM RESIDENCE ADDRESS	 	 	
3.  Relationship to minor: 	[  ] 	Mother	   [  ] 	Father 	  [  ] 	Guardian 	  [  ] 	Next Friend	   [  ]	 ..............................................	  	 
Provide the following info rmation about the minor.  
4.  Date and Place of Birth: 	........................................................................\
....................................................... .	 	                                                 DATE OF BIRTH                                                                                                                                          \
                  PLACE OF BIRTH  
 
5 .   City or county of residence: 	........................................................................\
................................................... 
 	
6.  Address if differen t from applicant’s: 	........................................................................\
....................................... 	       STREET  ADDRESS   
........................................................................\
.......................................................................................... 
 	CITY    STATE   ZIP  CODE      COUNTRY     	
 
7.  Father’s Full Name: 	
........................................................................\
.............................................................. 	   F IR ST    M ID DLE     L AST           S U FF IX  
 	
7a. Residence Address	: ......................................................................\
....................................................... .... 	   	      STREET ADDRESS 	
........................................................................\
.......................................................................................... 	 	CITY    STATE   ZIP  CODE      COUNTRY   
    	
7b. Mailing Address:	........................................................................\
.................. ...... 
 ....................................	      	IF DIFFERENT FROM RESIDENCE ADDRESS 
 	
8.  Mother’s Full Name: 	........................................................................\
.............................................................	 
    	FIRST     MIDDLE     MAIDEN                                  CURRENT LAST           
 	
8a. Residence Address:	 .......................................................................\
....................................................... ...	 	       STREET ADDRESS   
........................................................................\
.......................................................................................... 
 	CITY    STATE   ZIP  CODE      COUNTRY   
    	
8b. Mailing Address:	........................................................................\
.................. ...... 
 ....................................	      	IF DIFFERENT FROM RESIDENCE ADDRESS 
 	
Answer the following questions by check ing appropriate “Yes” or “No” box and providing information as requested.  
9.  Has the minor ever been convicted of a felony? 	
.......................................................................	 [  ] Yes  [  ] No 
10.  Is the minor currently incarcerated? ** 	
........................................................................\
..........	 [  ] Yes  [  ] No 
  If yes, indicate facility name: 	
........................................................................\
............................................	 
 Facility Location: 	
........................................................................\
...........................................................	 
11.  Is the minor a probationer with any court? ** 	
........................................................................\
.	 [  ] Yes  [  ] No 
  If yes, indicate court name: 	
........................................................................\
..............................................	 
 
 	
** An application for the change of name  of a probationer or incarcerated person MAY be accepted if the Court finds good 
cause exists for such application.  Attach  explanatory documentation to the application.

WHEREFORE, pursuant to § 8.01-217 of the Code of Virginia, 1950, as amended, the applicant requests that the Court 
fi
nd that a change of name is in the best interest of the minor and order a change of the minor’s name from: 
........................................................................\
................................................................................................  FIRST   MIDDLE    LAST         SUFFIX 
  to 
........................................................................\
................................................................................................  FIRST   MIDDLE    LAST         SUFFIX 
 
   ______________________________________________________________	 	  SIGNATURE OF APPLICANT    
Commonwealth/State of 	.............................................................. 	
 
[  ]  City  [  ]  County of 	............................................................... 	
 
The forgoing instrument was subscribed and sworn to/affirmed before me this 
 
.................	 day of 	...................................................................	 , 20 	................. 	
 
by 	
........................................................................\
................................................................... 	 NAME OF APPLICANT  
 
 ______________________________________________________________  
 
[  ]
   	CLERK 	   [  ] 	DEPUTY CLERK 	     [  ]  	NOTARY PUBLIC	  My commission expires:  ................................ 
   	
    Registration No. ......................................... 
 
 
[  ]  JOINT APPLICATION:  I join in this Application for Change of Name (Minor) 
 
Name: 	
........................................................................\
...................................................................................... 	  FIRST   MIDDLE   LAST   SUFFIX 	 
Residence Address: 	 .......................................................................\
....................................................... ............ 	       STREET ADDRESS   ........................................................................\
................................................................................................  CITY    STATE   ZIP CODE      COUNTRY      
Mailing Address: 	 .......................................................................\
...................................................................	 	      IF DIFFERENT FROM RESIDENCE ADDRESS  	
Relationship to minor:   	[  ] 	Mother	   [  ] 	Father 	    
 	
   ______________________________________________________________      SIGNATURE OF PERSON JOINING APPLICATION 
 
Commonwealth/State of 	
.............................................................. 	
 
[  ]  City   [  ]  County of 	
.............................................................. 
 	
The forgoing instrument was subscribed and sworn to/affirmed before me this  
..................	 day of 	...................................................................	 , 20 	................. 	 
by 	
........................................................................\
................................................................... 	  NAME OF PERSON JOINING APPLICATION 
 
 ______________________________________________________________  
 
[  ]   	CLERK 	[  ]  	DEPUTY CLERK 	 [  ]  	NOTARY PUBLIC  	My commission expires:  ................................ 
   R	
 egistration No. .........................................
Next: Vermont Name Change Instructional Form Previous: Virginia Adult Name Change Petition Form
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