Minnesota Name Change Forms – How to Change Your Name in MNMinnesota Name Change Forms – How to Change Your Name in MNMinnesota Name Change Forms – How to Change Your Name in MN
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State of Minnesota

District Court

County

Judicial District:
Court File Number:
Case Type:

Name Change

□ Interpreter Requested
Language
In the Matter of the Application of (current name):

First

Middle

Last

First

Middle

Last

First

Middle

Last

Application for Name Change
And Other Relief

For a change of name to (new name):

(Minn. Stat. § 259.10)
First

Middle

Last

First

Middle

Last

First

Middle

Last

State of Minnesota

)
) SS
)

County of

The undersigned applicant states that:
1. This application is made in good faith, without intent to defraud or mislead.
2. All persons who are asking to have their names changed on this application have lived in the
State of Minnesota for at least six months immediately prior to the date of this application, and
now live at:
Street

City/Town

State

Zip

County

3. Name of applicant and date of birth:
4. Name of applicant’s spouse and date of birth:
This application  does  does not include spouse.

NAM102

State

ENG

Rev 07/