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Request For Name Change (Adult) NC-R 303.1 - Illinois

Request For Name Change (Adult) Form. This is a Illinois form and can be used in La Salle Local County .
 Fillable pdf Last Modified 6/18/2014
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This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois courts. STATE OF ILLINOIS, CIRCUIT COURT COUNTY Instructions Enter above the county name where you will file this case. Enter your current name. DO NOT enter a Case Number, the Circuit Clerk will add it. For Court Use Only REQUEST FOR NAME CHANGE (ADULT) Request of: Your current name (First, middle, last name) Case Number I ask the court to enter an order to change my name, and I state: In 1, enter your complete current name. 1. My current name is: First Middle Last In 2, enter the new full name you would like. In 3, enter your complete current address. In 4, enter the date you started living in Illinois. In 5, enter the year you were born. DO NOT enter your entire date of birth. In 6, enter the city, county, state, and country where you were born. In 7, 8, and 9 check whether you have or have not been convicted or put on probation for the crime listed. If you checked "have" in 7 or 8 and have not been pardoned, the court cannot give you a name change. If you checked "have" in 9 and have not been pardoned or have not completed your probation or sentence over 10 years ago, the court may not give you a name change. 2. I wish my name to be changed to: First Middle Last 3. My address is: Street City State ZIP 4. 5. I have lived continuously in Illinois for at least 6 months beginning: Date My year of birth is: Year 6. My place of birth is: City County State/Province Country 7. I have have not been convicted of or placed on probation for a crime which requires me to register as a sex offender in Illinois or any other state. 8. I have have not been convicted of or placed on probation for identity theft or aggravated identity theft in Illinois or any other state. 9. I have have not been convicted of or placed on probation for a felony in Illinois or any other state. NC-R 303.1 This form shall not be modified. It may be supplemented with additional materials. Page 1 of 2 (03/14) American LegalNet, Inc. www.FormsWorkFlow.com Enter the Case Number given by the Circuit Clerk: _________________________________ In 10, describe what you were convicted of or placed on probation for, if you checked "have" in 7, 8, or 9. If you run out of space, use a separate piece of paper. 10. If you have been convicted or placed on probation for any crime, complete the following: Description of Felony or Misdemeanor Date of Conviction or Probation Sentence Received (include parole and supervised release) Date Sentence Completed Pardoned? (Yes or No) Check the box if you need language help and enter the language you speak. Under the Code of Civil Procedure, 735 ILCS 5/1-109, making a statement on this form that you know to be false is perjury, a Class 3 Felony. After you finish this form, sign and print your current name. Enter your complete current address and telephone number. Language Access If language help is available in court, I would like help. I speak: Language I certify that everything above is true and correct to the best of my knowledge. I understand that making a false statement in this form could be perjury. Your Signature Street Address Your Current Name City, State, ZIP Telephone NOTE This section should be filled out by someone else, not the person asking for a name change. Witness: Enter your full name. Under the Code of Civil Procedure, 735 ILCS 5/1-109, making a statement on this form that you know to be false is perjury, a Class 3 Felony. Witness: Sign and print your name. Witness: Enter your complete address. VERIFICATION BY WITNESS I, First Middle Last certify that what is stated above is true and correct to the best of my knowledge and belief. Witness Signature Witness Name Street Address City, State, ZIP This form shall not be modified. It may be supplemented with additional materials. Page 2 of 2 NC-R 303.1 (03/14) American LegalNet, Inc. www.FormsWorkFlow.com
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