Form 700-00123 "Petition to Change Name of Minor" - Vermont

What Is Form 700-00123?

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

Form Details:

  • Released on March 1, 2017;
  • The latest edition provided by the Vermont Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 700-00123 by clicking the link below or browse more documents and templates provided by the Vermont Superior Court.

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Download Form 700-00123 "Petition to Change Name of Minor" - Vermont

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STATE OF VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No.
In re:
PETITION TO CHANGE NAME OF MINOR
Part I. Request for Change of Name
The undersigned represents as follows:
That the minor's name is: _____________________________________________________________
That the minor was born at ________________________________________ on _________________
town/city/state
date of birth
That the parents of the minor are:
Name: __________________________________
Name: _________________________________
Address: ________________________________
Address: _______________________________
That the guardian, if any, for the child was appointed by ______________________________________
and has the following name and address:
Name: ______________________________________________________________________________
Address: ____________________________________________________________________________
Name of court: ____________________________
Address: _______________________________
☐ Parent
☐ Guardian
That my relationship to the child is:
That the name I wish the minor to be known as is ____________________________________________
I would like the minor’s birth certificate changed: ☐ YES
☐ NO
That the reason for changing the minor’s name is as follows:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
700-00123 – Petition Change Name of Minor (03/2017)
Page 1 of 2
STATE OF VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No.
In re:
PETITION TO CHANGE NAME OF MINOR
Part I. Request for Change of Name
The undersigned represents as follows:
That the minor's name is: _____________________________________________________________
That the minor was born at ________________________________________ on _________________
town/city/state
date of birth
That the parents of the minor are:
Name: __________________________________
Name: _________________________________
Address: ________________________________
Address: _______________________________
That the guardian, if any, for the child was appointed by ______________________________________
and has the following name and address:
Name: ______________________________________________________________________________
Address: ____________________________________________________________________________
Name of court: ____________________________
Address: _______________________________
☐ Parent
☐ Guardian
That my relationship to the child is:
That the name I wish the minor to be known as is ____________________________________________
I would like the minor’s birth certificate changed: ☐ YES
☐ NO
That the reason for changing the minor’s name is as follows:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
700-00123 – Petition Change Name of Minor (03/2017)
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I swear or affirm that the facts set forth in this petition are true and correct to the best of my knowledge and
belief.
On:
Date
Signature of Petitioner
At:
City, County and State
Printed Name
Being over the age of 14, I consent to the name change: ____________________________________________
Signature of Minor
Signed and sworn to before me:
Date
Signature of Notary Public
Expiration Date
Part II. Consent
I, _______________________________________ whose relationship with the minor is that of
_________________________________________ consent to the change of name of the minor from
_________________________________________ to the new name of _______________________________
At ____________________________ on this ____________day of ______________________, 20_________
______________________________________________
Signature
______________________________________________
Printed Name
______________________________________________
Mailing Address
______________________________________________
Telephone/Email
Note:
15 V.S.A. § 812 states that the name of a minor if over fourteen years of age shall not be changed without this consent
given in court.
700-00123 – Petition Change Name of Minor (03/2017)
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