PETITION FOR CHANGE OF NAME

IN RE:

____________________________________ Docket No. _________________ Petitioner (Print or Type)

Comes now the petitioner requesting change of name and makes oath and/or affirmation that the following facts are correct and complete:

1. My full name is _____________________________________________________________. I am a resident of ____________________________________ County, Tennessee, residing at: _______________________________________________. I am a citizen of __________________________.

2. I am more than 18 years of age. I was born on ____________________________________ in

___________________________, in ____________________________ County. The name given to me at (City) birth was __________________________________________________________ as reflected on my birth

certificate issued by the State of _________________________________________.

1. All other names and aliases by which I have been identified since birth are (state in chronological order): _________________________________________________________________________________, _______________________________________________________________________________________.

2. 4. I desire to change my name to: ______________________________________________________.
1. The reasons for the name change are: ________________________________________________ _______________________________________________________________________________________.

2. The change of my name will not adversely affect the rights of any minor children nor require that their names be changed. I am not seeking this change of name to evade the claims of my creditors, to evade legal process, nor for any other unlawful purpose.

7. a) I have not been convicted of a felony. �True � False b) I have been convicted of the felony of ________________________________________________.

8. In support of this Petition, I attach copies of my birth certificate, photo identification (such as a driver’s license, passport or comparable photo identification), and social security card.

I swear or affirm that I have read the Petition and the facts are correct and complete. Petitioner _________________________________

Sworn to and subscribed before me this _____ day of ________________, 19___.