Form CIV-GP-82F "Petition for Family Change of Name" - New York City

What Is Form CIV-GP-82F?

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 September 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;

Download a fillable version of Form CIV-GP-82F 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-82F "Petition for Family 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
FAMILY
CHANGE OF NAME
for Leave to Change Their Name(s) To
_____________________________________
____________________________(and ___________________________), by this petition, allege(s)
Primary Adult
(Second Adult, if any)
1.
The present family name is: ______________________________________________________.
2.
The new name which we propose to assume in place and stead of the present name is:
_____________________________________________________________________________.
3.
The individuals* whose names are included in this application are incorporated herewith are as follows:
Present Name
Proposed Name
Place of Birth
Date of Birth
Present Age
_________________________ ___________________
_____________
____________ _____________
_________________________ ___________________
_____________
____________ _____________
_________________________ ___________________
_____________
____________ _____________
_________________________ ___________________
_____________
____________ _____________
_________________________ ___________________
_____________
____________ _____________
_________________________ ___________________
_____________
____________ _____________
_________________________ ___________________
_____________
____________ _____________
*Primary Adult (and Secondary Adult, if any) and all minors under the age of 18 should be listed. Minors
between the ages of 14 and 18 must consent to this change by signing the Consent on page 2.
4.
The disclosure and publication of this name change would jeopardize one/all of the applicant’s personal safety
YES_______
NO________ because _________________________________________________________________
____________________________________________________________________________________________________
5.
One/some/all of the above named applicants have been convicted of a crime, adjudicated a bankrupt, or there is/are
judgments or liens against an applicant, or there is/are actions or proceedings pending against an applicant, or an applicant has
an obligation(s) for child and/or spousal support.
YES*_______
NO________
*If the answer to any part of this statement is YES for any applicant, each applicant who answers YES must fill out a CIV-
GP-82F supplemental form.
6.
Our present residence is: _______________________________________________________________________________
7.
The reasons for this application are as follows: ______________________________________________________________
____________________________________________________________________________________________________
CIV-GP-82F Page 1 (Revised September 2009)
Civil Court of the City of New York
County of ______________________
Index Number _________________
In the Matter of the Application of
PETITION FOR
FAMILY
CHANGE OF NAME
for Leave to Change Their Name(s) To
_____________________________________
____________________________(and ___________________________), by this petition, allege(s)
Primary Adult
(Second Adult, if any)
1.
The present family name is: ______________________________________________________.
2.
The new name which we propose to assume in place and stead of the present name is:
_____________________________________________________________________________.
3.
The individuals* whose names are included in this application are incorporated herewith are as follows:
Present Name
Proposed Name
Place of Birth
Date of Birth
Present Age
_________________________ ___________________
_____________
____________ _____________
_________________________ ___________________
_____________
____________ _____________
_________________________ ___________________
_____________
____________ _____________
_________________________ ___________________
_____________
____________ _____________
_________________________ ___________________
_____________
____________ _____________
_________________________ ___________________
_____________
____________ _____________
_________________________ ___________________
_____________
____________ _____________
*Primary Adult (and Secondary Adult, if any) and all minors under the age of 18 should be listed. Minors
between the ages of 14 and 18 must consent to this change by signing the Consent on page 2.
4.
The disclosure and publication of this name change would jeopardize one/all of the applicant’s personal safety
YES_______
NO________ because _________________________________________________________________
____________________________________________________________________________________________________
5.
One/some/all of the above named applicants have been convicted of a crime, adjudicated a bankrupt, or there is/are
judgments or liens against an applicant, or there is/are actions or proceedings pending against an applicant, or an applicant has
an obligation(s) for child and/or spousal support.
YES*_______
NO________
*If the answer to any part of this statement is YES for any applicant, each applicant who answers YES must fill out a CIV-
GP-82F supplemental form.
6.
Our present residence is: _______________________________________________________________________________
7.
The reasons for this application are as follows: ______________________________________________________________
____________________________________________________________________________________________________
CIV-GP-82F Page 1 (Revised September 2009)
PETITION FOR FAMILY CHANGE OF NAME - PAGE 2 of 2
Index no.
8.
W HEREFORE, your Petitioner(s) respectfully request(s) that an Order be granted permitting this requested change of name.
__________________________
__________________________________
Date
Signature of Petitioner
__________________________________
_
Signature of Second Adult
CONSENTS
I, _________________________________, am 14 years of age or over, and less than 18 years of age, and I have read
the annexed petition for family change of name, and I consent to the same.
___________________________________
_______________________________
Date
Signature
I, _________________________________, am 14 years of age or over, and less than 18 years of age, and I have read
the annexed petition for family change of name, and I consent to the same.
___________________________________
_______________________________
Date
Signature
I, _________________________________, am 14 years of age or over, and less than 18 years of age, and I have read
the annexed petition for family change of name, and I consent to the same.
___________________________________
_______________________________
Date
Signature
I, _________________________________, am 14 years of age or over, and less than 18 years of age, and I have read
the annexed petition for family change of name, and I consent to the same.
___________________________________
_______________________________
Date
Signature
VERIFICATION
State of New York, County of ___________ss.:
_____________________________________________________________, being duly sworn, deposes and say(s):
s/he/they is(are) the petitioner(s) named above, that s/he/they has/have read the petition and know(s) the truth of the contents
thereof except for those matters alleged to be on information and belief, and as to those matters, s/he/they believe(s) them to be
true, and that the signature(s) of the consenting party (parties) above is/are the true signature(s) of the minor child(ren) who is/are
included in the petition.
__________________________________
____________________________________________
Signature of Petitioner
Signature of Second Adult
Sworn to before me this ____ day of ________, 20___
Sworn to before me this _____ day of _________, 20___
_______________________________________
_______________________________________
Signature of Notary Public
Signature of Notary Public
CIV-GP-82F Page 2 (Revised September 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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