Form PC52 "Order Following Hearing on Petition to Change Name" - Michigan

What Is Form PC52?

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

Form Details:

  • Released on January 1, 2021;
  • The latest edition provided by the Michigan Circuit Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form PC52 by clicking the link below or browse more documents and templates provided by the Michigan Circuit Court.

ADVERTISEMENT
ADVERTISEMENT

Download Form PC52 "Order Following Hearing on Petition to Change Name" - Michigan

Download PDF

Fill PDF online

Rate (4.3 / 5) 15 votes
JIS Code: OCN
STATE OF MICHIGAN
CASE NO. and JUDGE
ORDER FOLLOWING HEARING ON
JUDICIAL CIRCUIT - FAMILY DIVISION
PETITION TO CHANGE NAME
COUNTY
(Part 1)
Court address
Court telephone no.
In the matter of
Present first, middle, and last name(s) (type or print)
THE COURT FINDS:
1. A petition for name change has been filed.
2. Notice of hearing was given by publication.
3. Each person for whom a name change is sought has been a resident of the county for at least one year.
4. The court has received the required criminal record report(s) from the Michigan Department of State Police.
5.
has a criminal record.
Name (type or print)
6. The request for the name change of
Name (type or print)
is
is not
made with fraudulent intent.
7. The petitioner, having legal custody, requests the name change of a minor. The noncustodial parent has consented to
the name change.
8. The petitioner requests the name change of a minor. The custodial parent has consented to the name change. The
noncustodial parent was given notice of the hearing.
a. The noncustodial parent has had the ability to visit, contact, or communicate with the minor but has regularly and
substantially failed or neglected to do so for the past two years, and
a support order has been entered, and the noncustodial parent has failed to substantially comply with the
or
order for a period of two years or more before the filing of the petition for name change.
a support order has not been entered and the noncustodial parent, having the ability to support or assist
supporting the child, has failed or neglected to provide regular and substantial support for two years or more
before the filing of the petition for name change.
b. The noncustodial parent has been convicted of child abuse
, criminal sexual conduct
(MCL 750.136b)
(MCL 750.520b,
, or assault with intent to commit criminal sexual conduct
and the child
750.520c, 750.520d, or 750.520e)
(MCL 750.520g),
or a sibling of the child was the victim.
9. The minor(s) 14 years of age or older signed a written consent to change name in the presence of the court.
10. The minor(s) under the age of 14 has/have stated a preference to a name change.
11. The minor(s) is/are not of sufficient age to express a preference to a name change.
Approved, SCAO
Distribute form to:
Form PC 52, Rev. 1/21
Court, Part 2
MCL 333.2872, MCL 711.1, MCR 3.613
Petitioner, Part 1
Page 1 of 2
Law enforcement, Part 1 (as needed)
Department of Corrections, Part 1 (as needed)
JIS Code: OCN
STATE OF MICHIGAN
CASE NO. and JUDGE
ORDER FOLLOWING HEARING ON
JUDICIAL CIRCUIT - FAMILY DIVISION
PETITION TO CHANGE NAME
COUNTY
(Part 1)
Court address
Court telephone no.
In the matter of
Present first, middle, and last name(s) (type or print)
THE COURT FINDS:
1. A petition for name change has been filed.
2. Notice of hearing was given by publication.
3. Each person for whom a name change is sought has been a resident of the county for at least one year.
4. The court has received the required criminal record report(s) from the Michigan Department of State Police.
5.
has a criminal record.
Name (type or print)
6. The request for the name change of
Name (type or print)
is
is not
made with fraudulent intent.
7. The petitioner, having legal custody, requests the name change of a minor. The noncustodial parent has consented to
the name change.
8. The petitioner requests the name change of a minor. The custodial parent has consented to the name change. The
noncustodial parent was given notice of the hearing.
a. The noncustodial parent has had the ability to visit, contact, or communicate with the minor but has regularly and
substantially failed or neglected to do so for the past two years, and
a support order has been entered, and the noncustodial parent has failed to substantially comply with the
or
order for a period of two years or more before the filing of the petition for name change.
a support order has not been entered and the noncustodial parent, having the ability to support or assist
supporting the child, has failed or neglected to provide regular and substantial support for two years or more
before the filing of the petition for name change.
b. The noncustodial parent has been convicted of child abuse
, criminal sexual conduct
(MCL 750.136b)
(MCL 750.520b,
, or assault with intent to commit criminal sexual conduct
and the child
750.520c, 750.520d, or 750.520e)
(MCL 750.520g),
or a sibling of the child was the victim.
9. The minor(s) 14 years of age or older signed a written consent to change name in the presence of the court.
10. The minor(s) under the age of 14 has/have stated a preference to a name change.
11. The minor(s) is/are not of sufficient age to express a preference to a name change.
Approved, SCAO
Distribute form to:
Form PC 52, Rev. 1/21
Court, Part 2
MCL 333.2872, MCL 711.1, MCR 3.613
Petitioner, Part 1
Page 1 of 2
Law enforcement, Part 1 (as needed)
Department of Corrections, Part 1 (as needed)
Order Following Hearing on Petition to Change Name (1/21)
Case No.
Page 2 of 2
12. The name(s) of the following person(s) is/are changed.
FROM
TO
DATE OF BIRTH
Petitioner
month, day, year
Spouse
month, day, year
Minor child
month, day, year
Minor child
month, day, year
Minor child
month, day, year
Minor child
month, day, year
13. The State Registrar shall create a new live birth certificate for
Name
that does not disclose the name at birth and shall seal the original certificate.
14. The request to change the name of
is denied.
Name
15. The request is denied and the petition is dismissed.
Judge signature and date
Attorney Name (type or print)
Bar no.
Address
City, state, zip
Telephone no.
Note to Petitioner: You must provide this order to the State Registrar if you want to change your birth certificate.
Note to Clerk: Under MCL 711.1(3), if the court enters an order to change the name of a person who has a criminal record,
the court shall forward the order to the Criminal Justice Information Center of the Michigan State Police and to one or more
of the following:
• The Department of Corrections if the person named in the order is in prison or on parole or has been imprisoned or
released from parole in the immediately preceding two years.
• The sheriff of the county in which the person named in the order was last convicted if the person was incarcerated in a
county jail or released from a county jail within the immediately preceding two years.
• The court that has jurisdiction over the person named in the order if the person named in the order is under the jurisdiction
of the family division of the circuit court.
JIS Code: OCN
STATE OF MICHIGAN
CASE NO. and JUDGE
ORDER FOLLOWING HEARING ON
JUDICIAL CIRCUIT - FAMILY DIVISION
PETITION TO CHANGE NAME
COUNTY
(Part 2)
Court address
Court telephone no.
In the matter of
Present first, middle, and last name(s) (type or print)
THE COURT FINDS:
1. A petition for name change has been filed.
2. Notice of hearing was given by publication.
3. Each person for whom a name change is sought has been a resident of the county for at least one year.
4. The court has received the required criminal record report(s) from the Michigan Department of State Police.
5.
has a criminal record.
Name (type or print)
6. The request for the name change of
Name (type or print)
is
is not
made with fraudulent intent.
7. The petitioner, having legal custody, requests the name change of a minor. The noncustodial parent has consented to
the name change.
8. The petitioner requests the name change of a minor. The custodial parent has consented to the name change. The
noncustodial parent was given notice of the hearing.
a. The noncustodial parent has had the ability to visit, contact, or communicate with the minor but has regularly and
substantially failed or neglected to do so for the past two years, and
a support order has been entered, and the noncustodial parent has failed to substantially comply with the
or
order for a period of two years or more before the filing of the petition for name change.
a support order has not been entered and the noncustodial parent, having the ability to support or assist
supporting the child, has failed or neglected to provide regular and substantial support for two years or more
before the filing of the petition for name change.
b. The noncustodial parent has been convicted of child abuse
, criminal sexual conduct
(MCL 750.136b)
(MCL 750.520b,
, or assault with intent to commit criminal sexual conduct
and the child
750.520c, 750.520d, or 750.520e)
(MCL 750.520g),
or a sibling of the child was the victim.
9. The minor(s) 14 years of age or older signed a written consent to change name in the presence of the court.
10. The minor(s) under the age of 14 has/have stated a preference to a name change.
11. The minor(s) is/are not of sufficient age to express a preference to a name change.
Approved, SCAO
Distribute form to:
Form PC 52, Rev. 1/21
Court, Part 2
MCL 333.2872, MCL 711.1, MCR 3.613
Petitioner, Part 1
Page 1 of 2
Law enforcement, Part 1 (as needed)
Department of Corrections, Part 1 (as needed)
Order Following Hearing on Petition to Change Name (1/21)
Case No.
Page 2 of 2
12. The name(s) of the following person(s) is/are changed.
FROM
TO
DATE OF BIRTH
Petitioner
month, day, year
Spouse
month, day, year
Minor child
month, day, year
Minor child
month, day, year
Minor child
month, day, year
Minor child
month, day, year
13. The State Registrar shall create a new live birth certificate for
Name
that does not disclose the name at birth and shall seal the original certificate.
14. The request to change the name of
is denied.
Name
15. The request is denied and the petition is dismissed.
Judge signature and date
Attorney Name (type or print)
Bar no.
Address
City, state, zip
Telephone no.
Note to Petitioner: You must provide this order to the State Registrar if you want to change your birth certificate.
Note to Clerk: Under MCL 711.1(3), if the court enters an order to change the name of a person who has a criminal record,
the court shall forward the order to the Criminal Justice Information Center of the Michigan State Police and to one or more
of the following:
• The Department of Corrections if the person named in the order is in prison or on parole or has been imprisoned or
released from parole in the immediately preceding two years.
• The sheriff of the county in which the person named in the order was last convicted if the person was incarcerated in a
county jail or released from a county jail within the immediately preceding two years.
• The court that has jurisdiction over the person named in the order if the person named in the order is under the jurisdiction
of the family division of the circuit court.
Page of 4