DISTRICT COURT OF
IN THE MATTER OF THE PETITION OF
Case No. _____________
Div. No. ______________
To Change His/Her Name to:
PURSUANT TO K.S.A. CHAPTER 60
PETITION FOR CHANGE OF NAME
Pursuant to K.S.A. 60-1402
1. I reside in the County in which this Petition is being filed.
2. I have been a resident of Kansas for more than sixty (60) days before filing this
3. My YEAR of birth is
and my place of birth is _________________________
County in the State of ______________________.
4. My birth certificate shows my name as:_____________________________________.
5. My present name is: ______________________________________________.
6. Other names I am using or have used are: ___________________________________
7. I desire to have my name changed to:_______________________________________