IN THE DISTRICT COURT FOR _______________ STATE, IN AND FOR _______________ COUNTY

   

In Re:  _______________________                  

(Name of Petitioner)

_______________________

                        _______________________

(Address of Petitioner)

 

 CASE NO. ___________________

 

                     DECREE

AND NOW TO WIT, on this ________ day of ____________________, 20_____, the above-captioned Petition For Name Change having come before the Court for hearing; the Court having reviewed said Petition and the Court being fully advised in the premises, finds that the necessary and appropriate information has been presented to the Court including the required Certificate of Live Birth of the Petitioner necessary for a Name Change under the laws of the State of ________________________.

 

THE COURT FINDS the following to have been confirmed:

a)      Petitionerís New Name:                                         ________________________________;

b)      Petitionerís Former Name:                                     ________________________________;

c)      Petitionerís Social Security Number:                     __________/__________/___________;

d)      Petitionerís Address:                                              ________________, _______________;

e)      Petitionerís Height:                                                 ____________ feet __________ inches;

f)        Petitionerís Weight:                                                 _________________________ pounds;

g)      Petitionerís Hair Color:                                           ________________________________;

h)      Petitionerís Eye Color:                                            ________________________________;

i)        Petitionerís Race:                                                    ________________________________;

j)        Petitionerís Sex as recorded on Birth Certificate: ________________________________;

k)     Petitionerís Date of Birth:                                       __________/__________/___________;

l)        Petitionerís Place of Birth:                                      ___________________, ____________;

m)    Petitionerís Hospital Location of Birth:                  ________________________________;

n)      Petitionerís Reason for Name Change:                  ________________________________;

IT IS THEREFORE ORDERED that, with all appropriate information provided to the Court and the Court having found that a name change for the Petitioner is in properly before the Court, the Petitioner shall henceforth be known as ____________________________________ (Petitionerís New Name).

IT IS FURTHER ORDERED BY THE COURT that the Registrar of the State of _______________ shall establish a new certificate of birth for the Petitioner as a person born in this State upon receipt by said Registrar of a notarized affidavit by a licensed physician or surgeon or appropriate osteopathic doctor stating that the Petitioner has undergone a completed sex change, by way of surgery or such comparable treatment, subject to further investigation and verification by said Registrar through the appropriate medical persons.  (Use This Paragraph In The Case Of Sex Change Only)

                                                                                    _______________________________________

Copies to:       ____________________                    (Judge of the _____________ Judicial District)

____________________

____________________                    In And For the State of __________________.

____________________

 

This is not a substitute for legal advice.  An attorney must be consulted.
Copyright © 1994 - 2015 by LAWCHEK, LTD.

This is not a substitute for legal advice.  An attorney must be consulted.
Copyright © 1994 - 2015 by LAWCHEK, LTD.

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