Enter the name of the county in which this case was filed.	STATE OF WISCONSIN, CIRCUIT COURT,                                                                 COUNTY	For Official Use
Enter your current name.  You are the Petitioner.	In the matter of the name change of:         _________________                                                                                                                                         First Name                                 MiddleName                                            Last Name
The clerk will enter the case number.
		Amended   Petition For Name Change (Adult or Minor 14 or Older) (30708)   Case No.

 

 

In 1, enter your address.

I am the Petitioner and state:

 

In 2, enter the date and state of your birth.

1.      My address is                                                                                                                                            

 

2.      I was born on (date)                                       in the state of                                                        .

In 3, enter the name on your birth certificate. In 4, enter the state that the birth certificate was issued. In 5, enter your job title.

 

3.      The name that appears on my birth certificate is                                                                           .

 

4.      My birth certificate was issued in the state of                                                                               

 

5.      My current job is                                                                                                                                       

 

In 6, check a or b.

6.       a. I do not work in a job for which a license has been required by any state, or my only professional license is to teach in the public schools in this state.

 

In 7, check the appropriate box.

 b. I do work in a job (other than a licensed teacher in Wisconsin public schools) for which a license has been required by any state.  However, I have notified the state board or commission for my profession and they do not object to my proposed name change.

 

In 8, enter your proposed new name.   Enter the reason(s) you want to change your name.

7.     I   am      am not         a convicted sex offender required to register under §§301.45, 938.34(15m), and 938.345(3), Wisconsin Statutes or a similar law of any other state. 

 

8.       I wish to change my name to                                                                                                                    .

                                                                        First Name                       Middle Name(s)                      Last Name

 

For the following reason(s):

 

STOP! Take this document to a Notary Public BEFORE you sign it.
After you have been sworn by a Notary Public, sign and print your name and date the document in front of the Notary Public.	4                                                  Signature                                                                                                                                                                                                                                                                       Print or Type Name                                                                                                                                                                                                                                                                                 Date
Have the Notary Public sign, date, and seal the document.	Subscribed and sworn to before me On                                                                                                                                                                                          Notary Public, State of Wisconsin My commission expires: