Form 41 "Affidavit of Consent of Infant of the Age of Fourteen (14) Years or Older" - Nassau County, New York

What Is Form 41?

This is a legal form that was released by the New York Supreme Court - a government authority operating within New York. The form may be used strictly within Nassau County. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the New York Supreme Court;
  • Easy to use and ready to print;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 41 by clicking the link below or browse more documents and templates provided by the New York Supreme Court.

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Download Form 41 "Affidavit of Consent of Infant of the Age of Fourteen (14) Years or Older" - Nassau County, New York

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[Fill in the spaces next to the instructions. Other spaces are for Court use.]
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
----------------------------------------------------------------------------x
In the Matter of the Application of
[1. Index No. & Year]
___________________________________________,
Index No.
[2. Fill in name(s)]
______________/_____
individually and as parent or guardian of the infant(s)
AFFIDAVIT OF CONSENT
OF INFANT OF THE AGE
___________________________________________,
OF FOURTEEN (14)
[3. Fill in infant current name]
YEARS OR OLDER
FOR LEAVE TO CHANGE INFANT(S) NAME(S) TO
___________________________________________,
[4. Fill in infant new name(s)]
-----------------------------------------------------------------------------x
STATE OF NEW YORK,
ss}
COUNTY OF NASSAU:
I, [5. Current Infant name]
being duly
sworn, deposes and says: that deponent is the infant in the within proceeding; has read
the foregoing petition of [6. Insert Name of Petitioner]
and joins in the prayer for relief and consents thereto.
[7. Infant Signature]
[8. Print Name]
Sworn to before me this
day of ______________, 20 __
Notary Public
[Fill in the spaces next to the instructions. Other spaces are for Court use.]
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
----------------------------------------------------------------------------x
In the Matter of the Application of
[1. Index No. & Year]
___________________________________________,
Index No.
[2. Fill in name(s)]
______________/_____
individually and as parent or guardian of the infant(s)
AFFIDAVIT OF CONSENT
OF INFANT OF THE AGE
___________________________________________,
OF FOURTEEN (14)
[3. Fill in infant current name]
YEARS OR OLDER
FOR LEAVE TO CHANGE INFANT(S) NAME(S) TO
___________________________________________,
[4. Fill in infant new name(s)]
-----------------------------------------------------------------------------x
STATE OF NEW YORK,
ss}
COUNTY OF NASSAU:
I, [5. Current Infant name]
being duly
sworn, deposes and says: that deponent is the infant in the within proceeding; has read
the foregoing petition of [6. Insert Name of Petitioner]
and joins in the prayer for relief and consents thereto.
[7. Infant Signature]
[8. Print Name]
Sworn to before me this
day of ______________, 20 __
Notary Public