Wisconsin Name Change Petition Form

This form, the Wisconsin Name Change Petition, must be filed with the county court clerk’s office to begin the name change process.Download

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P R IN T i n  I N K 	
CV-4 5 0,  1 0/1 0 P etit io n f o r N am e C ha nge ( A dult  o r M in o r 1 4 o r O ld e r)   §§3 01.4 5  a n d 7 86 .3 6, W is co nsin  S ta tu te s 	T h is  f o rm  s h all  n ot b e m odif ie d .   It  m ay b e s u pple m en te d  w it h  a d dit io nal  m ate ria ls  	P age 1  o f 2  	
E nte r t h e n am e o f t h e 
c o unty  i n  w hic h  t h is  
c ase  w as f ile d . 	S TA TE  O F W IS C O NSIN , C IR CUIT  C O URT,  
        	
 C O UNTY	 	
  Ente r y ou r c u rre n t 
n am e.  Y ou a re  t h e 
P etit io n er. 
 	
F or O ffic ia l  U se  	
      T he c le rk  w ill e n te r t h e 
c ase  n um ber.	
 	
  In  th e m atte r o f th e n am e c h ang e o f: 
 
        	_______________ __  	 	
F ir s t N am e   M id dle N am e   Last  N am e 	
 	
 A m end ed 	 	
P etit io n F or 
N am e C han ge 	
(A du lt  o r M in or 1 4  o r O ld er) 
( 3 070 8) 
 
C ase  N o.                             	
 	
 
I  a m  th e P etit io n er a n d s ta te : 
1 .  My a ddre ss is  	
(C ounty , S tr e et A ddre ss, C it y ,  S ta te  a nd Z ip )	         	 
 
 
 
.  
  2.  I w as b orn  o n 	
(D ate )  	        	 in  t h e s ta te  o f         	.   
  3.  The n am e th at a p pears  o n m y b ir th  c e rtif ic a te  is          
. 
  4.  My b ir th  c e rtif ic a te  w as is su ed in  th e s ta te  o f         
. 
  5.  My c u rre n t jo b is          
. 
  6. 	
 a . I d o n ot  w ork  in  a  jo b f o r w hic h  a  lic e nse  h as b een  r e qu ir e d b y a n y s ta te , o r m y o nly  
p ro fe ssio nal  lic e nse  is  to  t e ach  in  th e  p u blic  s ch ools  in  th is  s ta te . 
 b . I d o w ork  in  a  jo b ( o th er th an a  lic e nse d te ach er in  W is co nsin  p ublic  s ch oo ls ) fo r 
w hic h  a  lic e nse  h as b een r e qu ir e d b y a n y s ta te .  H ow eve r,  I h a ve  n o tif ie d  th e  s ta te  
b oard  o r c o m m is s io n f o r m y p ro fe ssio n a n d th ey d o n ot o bje ct t o  m y p ro pose d 
n am e c h ange. 
  7.  I  
 a m      	 a m  n ot          a  c o n vic te d s e x o ffe nder r e qu ir e d to  r e gis te r u nd er § § 301.4 5, 
9 38.3 4(1 5m ), a nd 9 38.3 45(3 ), W is co nsin  S ta tu te s o r a  s im ila r la w  o f a n y o th er s ta te .   
 
8.  I w is h  t o  c h a nge m y n am e to         	
. 	 	F ir s t N am e                            M id dle  N am e(s )                           L ast N am e 	
F or th e f o llo w in g  r e aso n(s ):  
        
          
  	
I n  1 , e n te r y o ur 
c o m ple te  a d dre ss. 
 
I n  2 , e n te r t h e d ate  a n d  
s ta te  o f y o ur b ir th .   
I n  3 , e n te r t h e n am e o n 
y o ur b ir th  c ertif ic ate .  
  I n  4 , e n te r t h e s ta te  
t h at t h e b ir th  
c ertif ic ate  w as i s su ed . 
 I n  5 , e n te r y o ur j o b 
t itle . 
I n  8 , e n te r y o ur 
p ro p ose d  n ew  n am e. 
  E nte r t h e r e aso n (s ) y o u 
w an t t o  c h an ge y o ur 
n am e. 
I n  6 , c h eck  a  o r b . 
I n  7 , c h eck  t h e 
a p pro p ria te  b o x.

Petit io n fo r N am e C hange   ( A dult  o r M in or 1 4 o r O ld er)  Page 2  o f 2   Case  N o. 	      	_ _ ______ 	
C V-4 5 0,  1 0/1 0  P etit io n fo r N am e C han ge –  A dult  o r M in o r 1 4 o r O ld e r   §§3 01.4 5  a n d 7 86 .3 6, W is co nsin  S ta tu te s 	T h is  f o rm  s h all  n ot b e m odif ie d .   It  m ay b e s u pple m en te d  w it h  a d dit io nal  m ate ria ls . 	P age 2  o f 2  
 	
S T O P! 	
T ak e t h is  d ocu m en t t o  a  N ota ry  P ublic  B EFO RE y ou  s ig n  i t . 	
 
A fte r y o u h av e b een  
s w orn  b y a  N ota ry  
P ubli c , s ig n  a n d  p rin t 
y o ur n am e a n d d ate  t h e 
d ocu m en t i n  f r o nt o f t h e 
N ota ry  P ubli c	
. 
 	
   	
 	
Sig natu re  	
 	      	 	
 	Prin t  o r T yp e N am e	 	
   	
     	 	
 	D ate	 	 	
H av e t h e N ota ry  P ub lic  
s ig n , d ate , a n d  s e al t h e 
d ocu m en t. 	
S ta te  o f          	  
C ounty  o f         
 
S ubscrib ed a nd s w orn  to  b efo re  m e o n	
        	 
   
 	N ota ry  P ublic /C ou rt O ffic ia l 	
 	 	N am e P rin te d o r T yp ed 	
M y c o m m is sio n/te rm  e xp ir e s: