Form CIV-GP-82M "Petition for Individual Minor's Change of Name" - New York City

What Is Form CIV-GP-82M?

This is a legal form that was released by the New York City Civil Court - a government authority operating within New York City. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2009;
  • The latest edition provided by the New York City Civil Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CIV-GP-82M by clicking the link below or browse more documents and templates provided by the New York City Civil Court.

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Download Form CIV-GP-82M "Petition for Individual Minor's Change of Name" - New York City

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Civil Court of the City of New York
County of ______________________
Index Number _________________
In the Matter of the Application of
PETITION FOR
INDIVIDUAL MINOR’S
CHANGE OF NAME
As Parent and Natural Guardian for leave
to Change Minor’s Name To
______________________________________
1.
________________________________________________________________, by this petition, alleges
2.
I am the _____________________________________________________________________ of a Minor
3.
The Minor’s present name is _____________________________________________________________.
4.
The name which I propose that the Minor will assume in place and stead of the Minor’s present name is:
_____________________________________________________________________________________.
5.
The Minor’s Age, Date of Birth and Place of Birth are: Age:__________ Date of Birth:________________
Place of Birth: _________________________________________________________________.
Note: If the Minor was 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 Commissioner or the local Board of
Health that no such Certificate is available.
6.
The Minor’s present residence is: __________________________________________________________
7.
For each of the following five statements , place your initials in the appropriate column.
YES
NO
a) The Minor’s personal safety would be jeopardized by the disclosure of this name change. ______ ______
b) The Minor has been convicted of a crime
______ ______
c) The Minor has been adjudicated a bankrupt
______ ______
d) There are judgments or liens of record against the Minor
______ ______
e) There is/are actions or proceedings pending to which the Minor is a party
______ ______
If you responded “YES” to any of the five statements above, please explain:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
(If additional space is required, attach (a) separate sheet(s) of paper with the details.)
)
CIV-GP-82M Page 1(Revised August 2009
Civil Court of the City of New York
County of ______________________
Index Number _________________
In the Matter of the Application of
PETITION FOR
INDIVIDUAL MINOR’S
CHANGE OF NAME
As Parent and Natural Guardian for leave
to Change Minor’s Name To
______________________________________
1.
________________________________________________________________, by this petition, alleges
2.
I am the _____________________________________________________________________ of a Minor
3.
The Minor’s present name is _____________________________________________________________.
4.
The name which I propose that the Minor will assume in place and stead of the Minor’s present name is:
_____________________________________________________________________________________.
5.
The Minor’s Age, Date of Birth and Place of Birth are: Age:__________ Date of Birth:________________
Place of Birth: _________________________________________________________________.
Note: If the Minor was 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 Commissioner or the local Board of
Health that no such Certificate is available.
6.
The Minor’s present residence is: __________________________________________________________
7.
For each of the following five statements , place your initials in the appropriate column.
YES
NO
a) The Minor’s personal safety would be jeopardized by the disclosure of this name change. ______ ______
b) The Minor has been convicted of a crime
______ ______
c) The Minor has been adjudicated a bankrupt
______ ______
d) There are judgments or liens of record against the Minor
______ ______
e) There is/are actions or proceedings pending to which the Minor is a party
______ ______
If you responded “YES” to any of the five statements above, please explain:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
(If additional space is required, attach (a) separate sheet(s) of paper with the details.)
)
CIV-GP-82M Page 1(Revised August 2009
PETITIONER FOR INDIVIDUAL M INOR’S CHANGE OF NAM E - PAGE 2
Index No.______________
8.
I have/have not made a previous application to change the Minor’s name in this or any other Court.
(If you have, give details and reason for this current application below.)
(Strike out one)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
9.
The reasons for this application are as follows: ___________________________________________
________________________________________________________________________________
________________________________________________________________________________
10.
W HEREFORE, your Petitioner respectfully requests that an Order be granted permitting this change of
name.
_______________________________
____________________________________
Date
Signature of Petitioner
VERIFICATION
State of New York, County of _____________ss.:
_______________________________________, being duly sworn, deposes and says:
s/he is the petitioner named above, that petitioner has read the petition and knows the truth of the contents thereof
except for those matters alleged to be on information and belief, and as to those matters, petitioner believes them to be
true.
Sworn to before me this _____ day of ____________, 20___
_________________________________________________
__________________________________
Signature of Notary Public
Signature of Petitioner
CIV-GP-82M Page 2 (Revised August 2009)
FREE CIVIL COURT FORM
No fee may be charged to fill in this form.
Form can be found at:
http://www.nycourts.gov/courts/nyc/civil/forms.shtml.
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