Affidavit Re Change Of Name (Minor) {PC-910A}

Affidavit Re Change of Name (Minor) PC-910A REV. 1/14 RECEIVED: CONNECTICUT PROBATE COURTS RECORDED: Instructions: 1) Submit with form PC-900, Petition for Change of Name (Minor). 2) Type or print the form in ink. District Number Probate Court Name In Re Change of Name of The subscriber, being duly sworn, hereby swears, affirms or avers that: 1. I have petitioned this court for a change of name of the above-named minor as next friend. 2. The minor presently lives at _____________________________________________________________ and has been a resident of _________________________________Connecticut for ______ years. 3. The minor owns real estate located in ________________________________________. 4. The minor does not have any outstanding debts that are in arrears. I will notify any creditors of the change of name of the minor. 5. A. There are no criminal charges pending against the minor. B. There are criminal charges pending against the minor as described below: C. The minor has never been convicted of any offense. D. The minor has been convicted of a criminal offense(s) as described below: Due to the nature of the minor's offense, the minor is obligated to register on the Sex Offender Registry, and, prior to filing this petition with the court, the commissioner of emergency services and public protection was notified in accordance with C.G.S. section 45a-99. Due to the nature of the minor's offense, the minor is obligated to register on the Deadly Weapons Offender Registry, and, prior to filing this petition with the court, the commissioner of emergency services and public protection was notified in accordance with C.G.S. section 45a-99. 6. The purpose of the change of name of the minor is not to deceive, defraud or mislead any person or governmental agency, nor to avoid the legal consequences of a criminal conviction. 7. There has has not been a previous petition for a change of name in either a Probate Court or the Superior Court in Connecticut or in a court of another state. Court name and address: Subscriber__________________________________ DATE SUBSCRIBED AND SWORN TO BEFORE ME Date:__________________ Judge, Clerk, Notary Public, Comm. of Superior Court Affidavit Re Change of Name (Minor) PC-910A REV. 1/14 American LegalNet, Inc. www.FormsWorkFlow.com