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NAME CHANGE QUESTIONNAIRE
(Adult Name Changes)
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* Indicates required question
Email
*
Your email
What is your current full legal name?
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Your answer
What is your current mailing address?
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Your answer
What is your phone number?
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Your answer
What is your date of birth?
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MM
/
DD
/
YYYY
What is your Mother's full legal name?
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Your answer
What is your Father's full legal name?
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Your answer
What is your Mother's maiden name?
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Your answer
FULL NAME YOU WISH TO CHANGE TO (Please have the correct spelling and include ALL names.)
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Your answer
Are you married?
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Yes
No
If you are married, what is your spouse's full legal name?
Your answer
Please list the places you have lived since birth. (Please include city/state and dates to-from)
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Your answer
Do you have any children?
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Yes
No
If you do have children, please list their names and ages.
Your answer
Has your name ever been changed by a court?
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Yes
No
Has your name ever been changed by marriage?
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No
Yes
Have you ever been known by or called any other names? (Please list nicknames, if applicable.)
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Your answer
What is your current occupation?
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Your answer
Do you own/operate a business?
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Yes
No
Please list schools you have graduated from, the degree(s) you have received, and the date of graduation.
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Your answer
Have you ever been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication?
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Yes
No
If yes, please list the date, city/state, and event.
Your answer
Have you ever been required to register as a sexual predator or a sexual offender?
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No
Yes
Have you ever been adjudicated bankrupt?
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Yes
No
Have you ever had a money judgment entered against you by a creditor?
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Yes
No
Are you seeking a name change for any illegal purpose?
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Yes
No
Have you ever had your civil rights suspended?
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Yes
No
Do you understand that you must have your fingerprints taken in a manner approved by the Dept. of Law Enforcement and submitted for a state and national criminal history records check?
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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