Vermont > Statewide > Probate Court
Petition Of Adult To Change Name 122 - Vermont
| Petition Of Adult To Change Name Form. This is a Vermont form and can be used in Probate Court Statewide . |
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Pc122 SUPERIORCOURT Unit Unit STATEOFVERMONT PROBATEDIVISION DocketNo.____________ Inre____________________________________________of_______________________________ PETITONOFADULTTOCHANGENAME The undersigned petitioner represents as follows: That I was born at ________________________ on _______________; town/city and state date of birth That I have the following minor children, who were born in the following locations: Name of child town/city and state date of birth ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ That I am married to __________________________________ of ______________________________ That the name I wish to be known by is: ___________________________________________________ That I understand that by filing this petition I consent to the court's requesting the Department of Public Safety to determine whether the petitioner's name appears on the sex offender registry established by 13 V.S.A. ยง 5402 and to disclosure of the information to the court by the department; and I understand that, if the department reports that the petitioner's name appears on the registry, the court shall permit the department to appear o the question whether there is a compelling reason for granting the petition. Date: __________________ Signed: _____________________________________,Petitioner Print Name: _________________________________ Mailing Address: _____________________________ ___________________________________________ Telephone/email:_____________________________ At __________________________ on this ______ day of ___________________, 20____, _________________________________________ personally appeared before me and acknowledged this instrument by him/her signed, to be his/her free act and deed. ____________________________________________ Judge/Register 10/11 SML American LegalNet, Inc. www.FormsWorkFlow.com
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