Transcription of Petition for Change of Name (Adult) …
1 Petition for Change of name (Adult) connecticut probate COURTS PC-901 REV. 10/17 Petition for Change of name (Adult) PC-901 RECEIVED: Instructions: 1) An individual 18 years of age or older may use this form to Petition for a Change of his or her name . 2)The Petition must be filed in the court for the probate district in which the petitioner resides andaccompanied by a) PC-910, Affidavit RE Change of name , b) a certified copy of the petitioner s long-form birth certificate and c) two forms of identification, one of which must be photographic identification. 3)The court will conduct a search of the sex offender registry and of the registry of offenders convicted ofcrimes with a deadly weapon and may conduct a full criminal background )For more information, see probate court Rules of Procedure sections and )Type or print the form in ink.
2 Use an additional sheet, or PC-180, if more space is court name District Number Petitioner s Current name : FirstMiddleLastPetitioner s Address and Telephone Number Date of Birth Place of Birth name on Birth Certificate (if different ) name to be Changed to: FirstMiddleLastSpouse ( name , address and telephone number.) The Petitioner represents that: A Change of name is sought for the following reasons: The purpose of seeking a Change of name is not to deceive, defraud or mislead any person or governmental agency, nor to avoid the legal consequences of a criminal conviction, but solely for the reason(s) stated above.
3 WHEREFORE, the petitioner requests a Change of name to the name stated above. The representations made in this Petition are made under the penalty of false statement. Signature of Petitioner Type or Print name Date connecticut probate COURTS CONFIDENTIAL INFORMATION/ Petition for Change of name (Adult) PC-901CI REV. 10/17 FOR court USE ONLY _____ Confidential Information/ Petition for Change of name (Adult) PC-901CI RECEIVED: probate court name District Number In the Matter of ,an adult The social security numbers of the following parties are required in connection with this proceeding for Change of name : 1) Petitioner: name _____ Social Security Number _____
