Form NCM-CI 2004.2 Request for Name Change - Child Information - Illinois

Form NCM-CI2004.2 or the "Request For Name Change - Child Information" is a form issued by the Illinois Circuit Court.

Download a PDF version of the Form NCM-CI2004.2 down below or find it 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 Circuit Courts.
For Court Use Only
STATE OF ILLINOIS,
CIRCUIT COURT
REQUEST FOR NAME CHANGE -
CHILD INFORMATION
COUNTY
Instructions
REQUEST OF:
Directly above, enter
the county name
where you will file this
case.
Enter the name of the
person asking the
court to change the
First, Middle, Last Name
Case Number
names of minor
children.
TO CHANGE NAMES OF MINOR CHILDREN
DO NOT enter a Case
Number, the Circuit
Clerk will add it.
In 1a, enter the
1. I am providing the following information about the minor child:
complete current name
a.
Name:
of 1 minor child whose
name you wish to
First
Middle
Last
change. This should be
the full name of the
child listed on their
b.
Date of birth is:
birth certificate. You
Date
should bring the child's
c.
Place of birth:
birth certificate with
City
County
State/Province
Country
you to court.
In 1b, enter the child’s
d.
Address is:
date of birth.
Street, Apt #
City
State
ZIP
In 1c, enter the child’s
place of birth.
In 1d, enter the child’s
2. My relationship to the child is:
complete current
 parent with custody/parental decision making responsibility; OR
address.
 guardian with legal custody; OR
In 2, select your
 the child has lived in my home for 3 years and is recognized as my adopted child.
relationship to the
minor child. If your
relationship is not
listed, you cannot ask
the court to change the
name of the child.
3. I am providing the following information about the child’s criminal history:
In 3a, 3b, and 3c check
whether the child has or
a. The child  has
 has not been convicted of or placed on probation for a crime
has not been convicted
which requires them to register as a sex offender in Illinois or any other state.
or put on probation for
the crime listed.
b. The child  has
 has not been convicted of or placed on probation for identity
If you checked “has” in
theft or aggravated identity theft in Illinois or any other state.
3a or 3b and the child
The child  has
 has not been convicted of or placed on probation for a felony
c.
has not been pardoned,
in Illinois or any other state.
the court cannot give
you a name change.
If you checked “has” in
3c and the child has not
been pardoned or has not
completed probation or
sentence over 10 years
ago, the court may not
give you a name change.
NCM-CI 2004.2
Page 1 of 2
(03/18)
This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts.
For Court Use Only
STATE OF ILLINOIS,
CIRCUIT COURT
REQUEST FOR NAME CHANGE -
CHILD INFORMATION
COUNTY
Instructions
REQUEST OF:
Directly above, enter
the county name
where you will file this
case.
Enter the name of the
person asking the
court to change the
First, Middle, Last Name
Case Number
names of minor
children.
TO CHANGE NAMES OF MINOR CHILDREN
DO NOT enter a Case
Number, the Circuit
Clerk will add it.
In 1a, enter the
1. I am providing the following information about the minor child:
complete current name
a.
Name:
of 1 minor child whose
name you wish to
First
Middle
Last
change. This should be
the full name of the
child listed on their
b.
Date of birth is:
birth certificate. You
Date
should bring the child's
c.
Place of birth:
birth certificate with
City
County
State/Province
Country
you to court.
In 1b, enter the child’s
d.
Address is:
date of birth.
Street, Apt #
City
State
ZIP
In 1c, enter the child’s
place of birth.
In 1d, enter the child’s
2. My relationship to the child is:
complete current
 parent with custody/parental decision making responsibility; OR
address.
 guardian with legal custody; OR
In 2, select your
 the child has lived in my home for 3 years and is recognized as my adopted child.
relationship to the
minor child. If your
relationship is not
listed, you cannot ask
the court to change the
name of the child.
3. I am providing the following information about the child’s criminal history:
In 3a, 3b, and 3c check
whether the child has or
a. The child  has
 has not been convicted of or placed on probation for a crime
has not been convicted
which requires them to register as a sex offender in Illinois or any other state.
or put on probation for
the crime listed.
b. The child  has
 has not been convicted of or placed on probation for identity
If you checked “has” in
theft or aggravated identity theft in Illinois or any other state.
3a or 3b and the child
The child  has
 has not been convicted of or placed on probation for a felony
c.
has not been pardoned,
in Illinois or any other state.
the court cannot give
you a name change.
If you checked “has” in
3c and the child has not
been pardoned or has not
completed probation or
sentence over 10 years
ago, the court may not
give you a name change.
NCM-CI 2004.2
Page 1 of 2
(03/18)
Enter the Case Number given by the Circuit Clerk: ____________________
In 4, select all the
4. It is in the best interest of the child that their name be changed because
(check all that apply):
reasons it is in the
 I wish to have the child’s name changed.
child's best interest to
 The child wishes to have their name changed.
change their name.
Use “Other” to add
 Other:
other reasons.
5. I am providing the following information about other parents
(do not include yourself or
In 5, if there is another
.
parents whose rights as parents have been terminated by a court order)
parent, list their name
 None
and address. If not,
 Name and address of other parent:
check "None."
First
Middle
Last
Street, Apt #
City
State
ZIP
In 6, if the parent listed
6. The other parent listed above agrees to this name change.
above agrees to this
 I don’t know
name change, have
 No
them sign their name in
front of an Illinois
 Yes (
If yes, have the other parent sign below)
notary public if they
are not going to be at
I,
the court date.
First
Middle
Last
consent to the child’s name change.
Signature (sign in front of an official Illinois notary public)
Notary Public
DO NOT complete
State of Illinois
this section. The notary
County of
will complete it.
Signed and sworn to before me on
by
.
Date
Name
Seal
Signature of Notary
In 7a or 7b, if there is
7. There is a second parent or person who is not the parent with physical custody of the child.
a second parent or a
a. There is a second parent.
person who is not the
parent with physical
Yes
(If yes, fill out and attach the Request for Name Change - Additional Parent form.)
custody of the child,
No
check "Yes" and fill
out and attach the
Request for Name
b. There is a person who is not the parent with physical custody of the child.
Change - Additional
Parent form. If not,
Yes
(If yes, fill out and attach the Request for Name Change - Additional Parent form.)
check "No."
No
(03/18)
NCM-CI 2004.2
Page 2 of 2
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