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 qCounty Court
qDistrict Court
_________________________________________ County, Colorado
Court Address:
IN THE MATTER OF THE PETITION OF:
FOR A CHANGE OF NAME TO:
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COURT USE ONLY
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Attorney or Party Without
Attorney (Name and Address):
Phone
Number:
E-mail:
FAX Number: Atty.
Reg. #:
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Case Number:
Division Courtroom
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PETITION FOR CHANGE OF NAME (ADULT)
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Petitioner states:
1.
My current full
name is _________________________________________ Date of Birth
_______________.
2.
I am 18 years of
age or older.
3.
I am a resident
of ___________________________________________
County, Colorado.
4.
I have not been
convicted of a felony or adjudicated as a juvenile delinquent for an offense
that would constitute an felony if committed by an adult in this state or any
other state or under federal law. My
fingerprint-based criminal history record check is attached as Exhibit A and is
dated within 90 days of the filing of this Petition pursuant to §13-15-101(b),
C.R.S.
5.
I wish to change
my name to _______________________________________________________________.
6. The reason I want to change my name
is ______________________________________________________
_______________________________________________________________________________________
______________________________________________________________________________________.
7.
The proposed
change of name would be proper and not detrimental to the interest of any other
person.
8.
I ask the Court
to order the name change.
I, ______________________________, swear/affirm under oath that
I have read the foregoing Petition and that the statements contained in this
Petition are true to the best of my knowledge and belief.
Date:
__________________________ __________________________________________________ Signature of Petitioner _________________________________________________
Address
__________________________________________________
City,
State, Zip Code
__________________________________________________
Telephone
#: (home) (work) (cell)
Subscribed
and affirmed, or sworn to before me in the County of ______________________,
State of ________________, this
___________ day of _______________, 20 _______.
My Commission Expires: ________________________ ___________________________________ Deputy Clerk/Notary Public
