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Application For Name Change NAM-102 - Minnesota

Application For Name Change Form. This is a Minnesota form and can be used in Name Change District Court Statewide .
 Fillable pdf Last Modified 9/22/2011
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State of Minnesota County Judicial District: Court File Number: Case Type: District Court Name Change In the Matter of the Application of (current name): First Middle Last First Middle Last First Middle Last For a change of name to (new name): Application for Name Change And / Or Additional Relief (Minn. Stat. ยง 259.10) Last First Middle First Middle Last First Middle Last The undersigned applicant sworn/affirmed on oath states that: 1. 2. This application is made in good faith, without intent to defraud or mislead. All persons who are asking to have their names changed on this application have lived in the State of Minnesota for at least six months immediately prior to the date of this application, and now live at: No. City/Town State Zip Street County 3. 4. Name of applicant and date of birth: Name of applicant's spouse and date of birth: This application does does not include spouse. Name(s) of minor child(ren) and date(s) of birth: This application does not include minor child(ren) listed above. This application includes the following minor child(ren) listed above: 5. 6. The name and address of the non-applicant parent is: The non-applicant parent is not known and his/her name is not shown on the birth certificate. 7. Applicant requests: To have his/her name changed to To have the name of his/her spouse changed to To have the names of his/her minor child(ren) changed to American LegalNet, Inc. www.FormsWorkFlow.com NAM102 State ENG Rev 3/10 www.mncourts.gov/forms Page 1 of 2 8. The criminal history of the following parties included in this application is: ____________________________________ _________________________________________________________________________________________________ The following parties included in this application have been convicted of a felony: List name, date of offense, and state. If no criminal history, write "No criminal history." If no felony convictions, write "No felony convictions." 9. Legal description of lands in the State of Minnesota upon which the following have a claim, interest, or lien: (Provide the legal description and attach additional pages if necessary) Applicant Spouse Child(ren) I am currently involved in a victim or witness protection program. I am an inmate in a correctional facility, and have attached the Inmate Affidavit for Name Change. 10. 11. 12. Other: . Date: Co-applicant's Signature (Spouse) Applicant's Signature Minor's Signature (14 or older) Address City ( ) Telephone Number State Zip State of Minnesota County of Verification , being duly sworn on oath, says that he/she has read the foregoing application and knows the contents thereof, and that the same is true of his/her own knowledge. Sworn/affirmed before me Date: Deputy Court Administrator / Notary Public Applicant's Signature My Commission Expires Co-applicant's Signature Minor's Signature (14 or older) American LegalNet, Inc. www.FormsWorkFlow.com NAM102 State ENG Rev 3/10 www.mncourts.gov/forms Page 2 of 2
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