West Virginia Name Change Petition Form

A resident of West Virginia must use this form to begin the name change process. Specifically, the form must be filed with the court clerk’s office in the applicant’s county of residence.Download

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IN 	THE-----	COURT 	OF 	KANAWHA 	COUNTY, 	WEST 	VIRGINIA 	
IN 	RE: 	CHANGE 	OF 	NAME 	FROM 	_________ 	_ 	
TO 	___________ 	_ 	
CIVIL 	ACTION 	NO.----	
PETITION 	
(check 	and 	complete one 	of the 	boxes 	below) 	
Comes 	now 	the Petitioner  and petitions  this Court 	to 	change  the D Petitioner  or the 	
D 	Petitioner's  child or ward's  name from 	
to 	----------------------------~------------------------------~ 
In 	support 	of 	this Petition,  the Petitioner  states as follows: 	
I. 	
He/she  is currently  over the age 	of 	eighteen  (18) years,  having  been born 	on 	
n. 	
D Petitioner  has been  a bona  fide resident 	of 	Kanawha  County, West Virginia  for 	at 	
least one (1) year  prior  to the  filing 	of 	this  Petition. 	
OR 	
0 	Petitioner  is a nonresident 	of 	Kanawha  County, West Virginia  but was  born  and 
married  in this  county  and was  previously  a resident 	
of 	this  county  for 	at 	least 
fifteen  (15) years. 	
III. 	
The name  change  is not  for the  purposes 	of 	avoiding  debt or creditors. 	
IV. 	
Petitioner  is not  a registered  sex offender  pursuant  to any  state  or federal  law. 	
v. 	
This name  change  is not  for purposes 	of 	avoiding  any state  or federal  law 
regarding  identity. 
VI. 	
This name  change  is not  sought  for any  improper  or illegal  purpose. 	
VII. 	
The Petitioner  is not  a convicted  felon in any  jurisdiction.

VIII. 	
D Petitioner 	or 	the  D Petitioner's  child or ward 	has 	been  known  as 	-------	
-----------' 	and the change 	of 	name  is requested  for the  following 
reasons: 	
--------------------------------------------	
Petitioner  is a divorced  woman who wishes 	to 	restore  her maiden  name; 	
cnherReason: 	---------------------------------------	
WHEREFORE,  your Petitioner  prays that the Court  declare  that he/she  shall 
henceforth 	
be 	known  as 	____________________ 	; and  for such  other 
and  further  relief as this  Court  may deem  just and proper. 
STATE 	
OF 	WEST  VIRGINIA, 	
COUNTY 	OF 	KANAWHA, 	TO-	WIT: 	
Petitioner 
ProSe 	
-------------------'' 	the Petitioner  named in the 
attached  Petition, being 	
first 	duly sworn, says  that the facts  and allegations  contained 	
in 	said Petition  are true;  except  insofar  as they  are therein  stated to 	be 	upon 
information  and belief,  he/she  believes  them to be  true. 
Petitioner 
Taken, subscribed 	
and 	sworn  to before  me, the undersigned  authority, this 	
__ 	day 	of 	, 20_. 	
My 	commission 	expires:--------------	
Notary Public 	in 	and for 
Kanawha  County, 
WV