New York Name Change Forms – How  to Change Your Name in NYNew York Name Change Forms – How  to Change Your Name in NYNew York Name Change Forms – How  to Change Your Name in NY
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________Court of the State of New York
County of ______________________

Index Number _________________

In the Matter of the Application of

for Leave to Change His/Her Name To

PETITION FOR
INDIVIDUAL ADULT
CHANGE OF NAME

____________________________________
1.

_____________________________________________________by this petition, alleges

2.

My present name is: ________________________________________________________________________.

3.

The name which I propose to assume in place and stead of my present name is:
_________________________________________________________________________________________.

4.

My Age, Date of Birth and Place of Birth are: Age: ____________ Date of Birth: _______________________

Place of Birth:_____________________________________________________________________________,
Note: If you were born in the State of New York you must attach either: a) a Birth Certificate, b) a Certified Transcript
of such Birth Certificate, or c) a Certificate from the Co