Vermont Name Change Forms – How to Change Your Name in VT
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Pc 122

STATE OF VERMONT

SUPERIOR COURT

PROBATE DIVISION

Unit

Unit

Docket No.____________

In re ____________________________________________ of _______________________________

PETITION OF ADULT TO CHANGE NAME
The undersigned petitioner represents as follows: 
That I was born at ________________________ on _______________; 
town/city and state

      date of birth

That I have the following minor children, who were born in the following locations: 
Name of child

town/city and state

date of birth

______________________________________________________________________________________________________________________________ 
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________

That I am married to __________________________________ of ____________________