Form NC-R 303.5 Request for Name Change (Adult) - Illinois

Form NC-R303.5 or the "Request For Name Change (adult)" is a form issued by the Illinois Circuit Court.

The form was last revised in March 1, 2018 and is available for digital filing. Download an up-to-date Form NC-R303.5 in PDF-format down below or look it up on the Illinois Circuit Court Forms website.

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This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois courts.
For Court Use Only
STATE OF ILLINOIS,
CIRCUIT COURT
REQUEST FOR NAME CHANGE
(ADULT)
COUNTY
Instructions
Request of:
Directly above, enter
the county name
where you will file
this case.
Enter your current
name.
Your current name (First, middle, last name)
DO NOT enter a Case
Number, the Circuit
Case Number
Clerk will add it.
In 1, enter your
I ask the court to enter an order to change my name, and I state:
complete current
1.
My current name is:
name.
In 2, enter the new full
name you would like.
First
Middle
Last
In 3, enter your
2.
I wish my name to be changed to:
complete current
address.
First
Middle
Last
In 4, enter the date
3.
My address is:
you started living in
Street
City
State
ZIP
Illinois.
4.
I have lived continuously in Illinois for at least 6 months beginning:
Date
In 5, enter your date of
birth
5.
My birth date is:
Date
In 6, enter the city,
county, state, and
6.
My place of birth is:
country where you
City
County
State/Province
Country
were born.
In 7-9, check the
7.
I
have
have not
been adjudicated or convicted of a felony or
boxes that apply to
your criminal history.
misdemeanor in Illinois or any other state for which a pardon has not been granted.
In 10, 11, and 12
check whether you
8.
I
do
do not
have an arrest for which charges have not been filed.
have or have not been
convicted or put on
probation for the
9.
I
do
do not
have a pending felony or misdemeanor charge.
crime listed.
If you checked “have”
have
have not
10.
I
been convicted of or placed on probation for a crime
in 10 or 11 and have
not been pardoned, the
which requires me to register as a sex offender in Illinois or any other state.
court cannot give you
a name change.
11.
I
have
have not
been convicted of or placed on probation for identity
If you checked “have”
theft or aggravated identity theft in Illinois or any other state.
in 12 and have not
been pardoned or have
not completed your
12.
I
have
have not
been convicted of or placed on probation for a felony in
probation or sentence
Illinois or any other state.
over 10 years ago, the
court may not give
you a name change.
NC-R 303.5
Page 1 of 2
(03/18)
This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois courts.
For Court Use Only
STATE OF ILLINOIS,
CIRCUIT COURT
REQUEST FOR NAME CHANGE
(ADULT)
COUNTY
Instructions
Request of:
Directly above, enter
the county name
where you will file
this case.
Enter your current
name.
Your current name (First, middle, last name)
DO NOT enter a Case
Number, the Circuit
Case Number
Clerk will add it.
In 1, enter your
I ask the court to enter an order to change my name, and I state:
complete current
1.
My current name is:
name.
In 2, enter the new full
name you would like.
First
Middle
Last
In 3, enter your
2.
I wish my name to be changed to:
complete current
address.
First
Middle
Last
In 4, enter the date
3.
My address is:
you started living in
Street
City
State
ZIP
Illinois.
4.
I have lived continuously in Illinois for at least 6 months beginning:
Date
In 5, enter your date of
birth
5.
My birth date is:
Date
In 6, enter the city,
county, state, and
6.
My place of birth is:
country where you
City
County
State/Province
Country
were born.
In 7-9, check the
7.
I
have
have not
been adjudicated or convicted of a felony or
boxes that apply to
your criminal history.
misdemeanor in Illinois or any other state for which a pardon has not been granted.
In 10, 11, and 12
check whether you
8.
I
do
do not
have an arrest for which charges have not been filed.
have or have not been
convicted or put on
probation for the
9.
I
do
do not
have a pending felony or misdemeanor charge.
crime listed.
If you checked “have”
have
have not
10.
I
been convicted of or placed on probation for a crime
in 10 or 11 and have
not been pardoned, the
which requires me to register as a sex offender in Illinois or any other state.
court cannot give you
a name change.
11.
I
have
have not
been convicted of or placed on probation for identity
If you checked “have”
theft or aggravated identity theft in Illinois or any other state.
in 12 and have not
been pardoned or have
not completed your
12.
I
have
have not
been convicted of or placed on probation for a felony in
probation or sentence
Illinois or any other state.
over 10 years ago, the
court may not give
you a name change.
NC-R 303.5
Page 1 of 2
(03/18)
Enter the Case Number given by the Circuit Clerk: _________________________________
In 13, describe what
13.
If you checked "have" in 10, 11, or 12 complete the following:
you were convicted of
Description of
Date of
Sentence Received
Date
or placed on probation
Felony or
Conviction or
(include parole and
Sentence
Pardoned?
for, if you checked
“have” in 10, 11, or
Misdemeanor
Probation
supervised release)
Completed
(Yes or No)
12.
If you run out of
space, use a separate
piece of paper.
Under the Code of
I certify that everything above is true and correct. I understand that making a false statement
Civil Procedure,
735
on this form is perjury and has penalties provided by law under
735 ILCS
5/1-109.
ILCS
5/1-109, making
a statement on this
form that you know to
/s/
be false is perjury, a
Your Signature
Street Address
Class 3 Felony.
If you are completing
this form on a
computer, sign your
Print Your Name
City, State, ZIP
name by typing it. If
you are completing it
by hand, sign and
print your name.
Telephone
GETTING COURT DOCUMENTS BY EMAIL: If you agree to receive court documents by email, check the box below and enter your email
address. You should use an email account that you do not share with anyone else and that you check every day. If you do not check your email
every day, you may miss important information or notice of court dates. Other parties may still send you court documents by mail.
I agree to receive court documents at this email address during my entire case.
Email
NOTE
VERIFICATION BY WITNESS
This section should
be filled out by
someone else, not the
I,
person asking for a
First
Middle
Last
name change.
Witness: Enter your
certify that what is stated above is true and correct to the best of my knowledge and belief.
full name.
Under the Code of
Civil Procedure,
735
ILCS
5/1-109,
Witness Signature
making a statement
on this form that you
know to be false is
Witness Name
perjury, a Class 3
Felony.
Street Address
Witness: Sign and
print your name.
Witness: Enter your
complete address.
City, State, ZIP
NC-R 303.5
Page 2 of 2
(03/18)
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Download Form NC-R 303.5 Request for Name Change (Adult) - Illinois

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