Vermont > Statewide > Probate Court
Petition To Change Name Of Minor 123 - Vermont
| Petition To Change Name Of Minor Form. This is a Vermont form and can be used in Probate Court Statewide . |
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Probate Court Form No. 123 Petition to Change Name of Minor STATE OF VERMONT DISTRICT OF__________________, SS. IN RE ____________________________ OF _______________________________ PROBATE COURT DOCKET NO.____________ PETITION TO CHANGE NAME OF MINOR Part I. Request for Change of Name The undersigned represents as follows: That the minor's name is________________________________________. That the minor was born at ______________________________________ on______________; date of birth town/city and state That the parents of the minor are: Name:___________________________ Address: _______________________ ________________________________ ________________________________ Name:________________________ Address: ____________________ _____________________________ _____________________________ That the guardian, if any, for the child was appointed by __________________and has the following name and address: ________________________________________________________________ Name of court:______________________ Address: ___________________________ _____________________________________ That my relationship to the child is: parent ( ) guardian ( ) That the name I wish the minor to be known as is ___________________________. That the reason for changing the minor's name is as follows: ________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Dated ______________________ Petitioner __________ American LegalNet, Inc. www.FormsWorkFlow.com Being over the age of 14, I consent to the name change: ___________________________ Minor At ____________________on this _____day of ______________, 20__, personally appeared before me and acknowledged this instrument, by him/her subscribed, to be his/her free act and deed. ______________________________________ Judge/Register That I [ ] do [ ] do not wish to change the birth certificate. Part II. Consent I,_________________, whose relationship with the minor is that of __________________consent to the change of name of the minor from ____________________to the new name of _________________________. Dated at ______ this ____ day of ___________, 20__. Signed ___________________________ Print Name _______________________ Address __________________________ __________________________________ __________________________________ Tel: (___) _______________________ ___________________________________________ Notary Public - My commission expires on ______________________________. Note: 15 V.S.A. ' 812 states that Athe name of a minor if over fourteen years of age, shall not be changed without his consent given in court.@ American LegalNet, Inc. www.FormsWorkFlow.com
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