Mississippi Name Change Forms – How to Change Your Name in MSMississippi Name Change Forms – How to Change Your Name in MS
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Petition for Change of Name of Adult
State of Mississippi
County of ________________

Court _____________________________
Docket No. ________________________

Name of
Petitioner:_____________________________ In re: Change of Name of Adult
From: _____________________________
To: _______________________________
Petitioner makes the following declaration:
1. Birth Date and Place: Petitioner was born on _______________________, ______ in
________________________ [city], ________________________ [county],
________________________ [state]. A certified copy of petitioner's birth certificate is attached
to this petition.
2. Birth Name: Petitioner was named ____________________________________________ at
birth, and as of the date of this petition, the Petitioner has always been known by that name,
with the following exceptions, if any:
_____________________________________________________________________________
_____________________________________________________________________________
_____