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Application For Adult Name Change (Adults Only) - Virginia
| Application For Adult Name Change (Adults Only) Form. This is a Virginia form and can be used in Circuit Court Virginia Beach Local County . |
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VIRGINIA: IN THE CIRCUIT COURT OF THE CITY OF VIRGINIA BEACH APPLICATION FOR ADULT NAME CHANGE - VA. CODE § 8.01-217 (ADULTS ONLY) NAME OF APPLICANT: CASE NO: ________________________________________________________________ _______________________________ NOW comes the above-named applicant, who states under oath that the information contained in this application and in any attachments to this document are both correct and accurate. 1. My Birth Name is: _________________________________________________________________________ 2. My current name is: __________________________________ 3. I am applying to change my name to: _________________________________________________________ 4. My Residence Address is: __________________________________________________________________ 5. My Date of Birth is: __________________________________________ 6. My Place of Birth is: _______________________________________________________________________ 7. My Father's Full Name: ____________________________________________________________________ 8. My Mother's Current Full Name: _____________________________________________________________ 9. Mother's Maiden Name: ____________________________________________________________________ 10. This name change is not sought for any fraudulent purposes and will not infringe upon the rights of others. 11. Have you ever been convicted of felony? _______.If yes, a copy of my conviction record is attached. 12. Are you currently incarcerated? __________ If yes, attached is a written explanation why good cause exists for this application. If yes, state the facility's name and location: ____________________________________________________ 13. Are you a probationer with any court? _________ If yes, indicate the name of the court which placed you probation: ___________________________________ If yes, attached is an explanatory documentation why good cause exists for this application. 14. Have you previously changed your name? _____. If yes, attach court order or documentation of the previous name change(s) and list all former name(s) in a "from" and "to" format: _______________________________________________________________________________________ _______________________________________________________________________________________ ______________________________________________ Signature of Applicant (Current Legal Name) AFFIDAVIT Subscribed and sworn to/affirmed before me. The applicant has provided one of the following documents to establish his/her identity (a copy of which is attached to this application): a United States Passport, a certificate of United States citizenship, a certificate of naturalization, an unexpired foreign passport, an alien registration card with photograph, a state-issued driver's license or state-issued identification card or a United States military card (Virginia Code § 47.1-14). DATE: _________________________ ___________________________________________________ DEPUTY CLERK OR Commonwealth/State of: _________________________; Cty/County of: _______________________________________ Subscribed and sworn to/affirmed before me. The identity of the applicant is personally known to me, or was ascertained by examination of one or more of the following documents: a United States Passport, a certificate of United States citizenship, a certificate of naturalization, an unexpired foreign passport, an alien registration card with photograph, a state-issued driver's license or state-issued identification card or a United States military card (Virginia Code § 47.1-14). DATE: ________________________ ___________________________________________________ Signature of Notary My commission expires: ________________________ Printed Name of Notary: _______________________________ American LegalNet, Inc. www.FormsWorkflow.com
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