Rhode Island > Statewide > Probate Court > Name Change And Adoption
Change Of Name PC-8.1 - Rhode Island
| Change Of Name Form. This is a Rhode Island form and can be used in Name Change And Adoption Probate Court Statewide . |
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PC-8.1 (11/02, formerly SW-19) Change of Name Date filed: _____________________ Court use only STATE OF RHODE ISLAND County of ___________________________________ PROBATE COURT OF THE Estate of ____________________________________ _________________________________________________ Alias _______________________________________ Alias _______________________________________ No. ____________________ ____________________ Date CHANGE OF NAME The undersigned petitioner requests the following name change: [ ________________________________________________________________________ __ Current Name ________________________________________________________________________ __ No. Street ________________________________________________________________________ __ City/Town State Zip Phone Number ________________________________________________________________________ __ Mailing Address (if different) No. Street ________________________________________________________________________ __ Mailing Address (if different) City/Town State Zip Name on Original Birth Record: ___________________________________________________ __ Date of Birth: __________________________ Place of Birth: __________________________ Mothers Maiden Name: ____________________ Fathers Name: ____________________ Petitioners Occupation: ____________________________________________ ________________ Petitioners Marital Status (optional): ____________________________________________________ The petitioner resided at the following addresses: ________________________________________________________________________ ________ ________________________________________________________________________ ________ ________________________________________________________________________ ________ Reason for name change (be specific): _______________________________________________ __ Petitioner requests a name change to: __________________________________________________ If applicable, the name on the birth record should be changed to: ________________________________________________________________________ ________ (continued on page 2) <<<<<<<<<********>>>>>>>>>>>>> 2PC-8.1 (11/02, formerly SW-19) If minor: _______________________________________________ _______________________________________________ Father Signature Mother Signature Attach form PC9.1, Waiver, if applicable. The undersigned petitioner makes affidavit and says that the above facts are true as to the best of his/her knowledge f. and belie __________________________________________ __________________________________________ Signature of petitioner Date _____________________________________________________ Relationship of petitioner _____________________________________________ Sc. Subscribed and sworn to before me as to the truth of all of the above facts by the petitioner. __________________________________________ __________________________________________ Notary public (please print nam e) Notary public signatur e DECREE Upon hearing, it is hereby ordered and decreed: _______________________________________________ _______________________________________________ Date Probate Judge Attach certified copy of the original birth certificate and BCI Report.
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