INSTRUCTIONS NAME CHANGE PETITION FOR MINOR (UNDER THE AGE OF 18)
IT IS STRONGLY RECOMMENDED THAT YOU CONSULT AN ATTORNEY
DISCLAIMER
THE SELF HELP CENTER STAFF AND THE STAFF IN ANY COURT OFFICE ARE UNABLE TO GIVE YOU LEGAL ADVICE. THE INFORMATION IN THIS PACKET IS NOT A SUBSTITUTE FOR PROFESSIONAL LEGAL ADVICE. THE COURT ASSUMES NO RESPONSIBILITY AND ACCEPTS NO LIABILITY FOR ACTIONS TAKEN BY USERS OF THESE DOCUMENTS, INCLUDING RELIANCE ON THEIR CONTENTS. IF YOU WANT TO OBTAIN THE SERVICES OF AN ATTORNEY BUT DO NOT KNOW WHOM TO CONTACT, YOU MAY CALL THE DAUPHIN COUNTY LAWYER REFERRAL SERVICE AT (717) 2327536.
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PETITION FOR A NAME CHANGE FOR A MINOR UNDER THE AGE OF 18 IF YOU ARE OVER THE AGE OF 18, DO NOT USE THESE FORMS AND INSTRUCTIONS. USE THE FORMS AND INSTRUCTIONS FOR AN ADULT NAME CHANGE
PLEASE NOTE: YOU MUST RESIDE IN DAUPHIN COUNTY IN ORDER TO FILE A PETITION FOR A NAME CHANGE IN DAUPHIN COUNTY.
The Order for a court hearing, Petition, Verification and Decree must be prepared using the blank forms attached. ORDER At the top of the Order, the name of the parent(s) and the name of the minor child must be entered. (If you are petitioning to change the name of your minor child, you are the Petitioner on behalf of your minor child.) You will receive a case number when you file the forms with the Prothonotarys Office. Do not fill out anything under the word Order. However, fill in your name and address under the word Distribution at the bottom of the page. PETITION FOR CHANGE OF NAME At the top of the form, print your name, address, telephone number, and email address (if you have one). LINE 1. LINE 2. LINE 3. Print the Minor Childs name and complete address. Enter the Minor Childs DATE of birth. Enter all addresses where the Minor Child has lived in the past five (5) years. Enter the new name that the Minor Child desires to have. List the names and address(es) of the Minor Childs parents. Enter the reasons why the Minor Child wants to change his or her name. The court will not grant a name change if that name change is harmful to the interests of another person or if the name change would defraud creditors. 2
LINE 4. LINE 5. LINE 6.
LINE 7-8.
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LINE 9c.
Enter the Minor Childs current name followed by the name that the Minor Child now desires to have.
The parent(s) filing the petition must sign the petition. Print the Petitioners name under the signature. VERIFICATION Fill out the form. Sign and date the Verification. Print Petitioners name under the signature. DECREE FOR CHANGE OF NAME At the top of the Decree, enter the name of the parent and the name of the child. Do not fill in the date. The Court will date the decree. Fill in the appropriate spaces with the name of the Minor Child and the name that the Minor Child desires to have. The Court will sign the Decree if the Court determines that the Name Change Petition should be granted. Fill in the name and address of the Petitioner at the bottom of the page under the heading Distribution. If a minor desires to change his or her name, both parents must be served with a copy of the Petition and notice of the date and time of the hearing. This means that the filing parent must send a copy of the Petition for Name Change and the copy of the scheduling order to the childs other parent. It is suggested that you send this certified mail, restricted delivery and by regular mail.
PROOF THAT THE OTHER PARENT RECEIVED A COPY OF THE PETITION AND THE ORDER SCHEDULING THE HEARING MUST BE PROVIDED TO THE JUDGE AT THE HEARING IF THE OTHER PARENT DOES NOT ATTEND THE HEARING.
Once you have completed an original copy, make two (2) copies for a total of three (3) completed petitions. Take the original with the two (2) copies, and a filing fee of $145.50 (payable by cash, certified check or money order made payable to Dauphin County Prothonotary) to the Prothonotarys Office located on the first floor of the Dauphin County Courthouse Room 101, Front and Market Streets, Harrisburg, PA 17101. The Prothonotarys Office will give your case a docket number and collect the fees. After the Petition is filed, go to your local police department to get fingerprinted. If you do not have a local police department, go to the Pennsylvania State Police Barracks located at 8000 Bretz Drive, Harrisburg (Hours: M-TH 8:00 a.m.-12:00 p.m. 12:30 p.m. 3:30 p.m. Tuesday extended hours 6:00 p.m.- 9:00 p.m.) and get fingerprinted. Bring the fingerprint card back to the Prothonotarys Office. The Prothonotarys Office will send the fingerprint card to the Pennsylvania State Police for a
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report. The Pennsylvania State Police will send a formal report to the Prothonotarys Office. Fingerprints are not required for children under twelve years of age. When the Pennsylvania State Police report is received by the Prothonotarys Office, the file will be sent to the Court Administrators Office for assignment to a judge. The assigned judge will issue a scheduling order. After you have received the information for the hearing date and time, you must publish the hearing date and time in both a newspaper of general circulation in Dauphin County and the Dauphin County Reporter, unless the Court directs otherwise. The Dauphin County Reporter is the designated legal periodical for Dauphin County. Contact the Dauphin County Bar Association at (717) 232-7536 for information on publishing in the Dauphin County Reporter. No more than 48 hours prior to your hearing, an official search of the proper offices of any county where the child has resided within the past five (5) years must be conducted. Proper certification is required from the Prothonotarys Office verifying that there are no judgments, decrees of record or any other of like character against the child. The Prothonotarys Office will complete a certification form after the search has been completed. The Dauphin County Prothonotarys Office fee for certifying a search in Dauphin County is $11.50 (payable by cash, certified check, or money order made payable to Dauphin County Prothonotary). On the day of your hearing, you must have: a. proof of publication; and b. signed certification of a name search from the Prothonotarys Office in each county where the child has resided for the last five (5) years. If the Court determines at the hearing that all of the requirements of the name change statute have been met, the Court may order the name change. You will receive a certified copy of the order from the Prothonotarys Office after you pay to the Prothonotarys Office the sum of $20.50 (payable by cash, certified check, or money order made payable to Dauphin County Prothonotary).
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FORMS NAME CHANGE PETITION FOR MINOR UNDER THE AGE OF 18
IT IS STRONGLY RECOMMENDED THAT YOU CONSULT AN ATTORNEY
DISCLAIMER
THE SELF HELP CENTER STAFF AND THE STAFF IN ANY COURT OFFICE ARE UNABLE TO GIVE YOU LEGAL ADVICE. THE INFORMATION IN THIS PACKET IS NOT A SUBSTITUTE FOR PROFESSIONAL LEGAL ADVICE. THE COURT ASSUMES NO RESPONSIBILITY AND ACCEPTS NO LIABILITY FOR ACTIONS TAKEN BY USERS OF THESE DOCUMENTS, INCLUDING RELIANCE ON THEIR CONTENTS. IF YOU WANT TO OBTAIN THE SERVICES OF AN ATTORNEY BUT DO NOT KNOW WHOM TO CONTACT, YOU MAY CALL THE DAUPHIN COUNTY LAWYER REFERRAL SERVICE AT (717) 2327536.
Revised 10-10 Dauphin County Court of Common Pleas
IN RE: CHANGE OF NAME OF
______________________________
(NAME OF PARENT) _____________________________________________ (NAME OF MINOR CHILD)
: IN THE COURT OF COMMON PLEAS : DAUPHIN COUNTY, PENNSYLVANIA : : NO. __________________
:
ORDER AND NOW, this ________ day of _____________, 20__, it is hereby ordered that a hearing in the above-captioned name change matter is scheduled for the ______ day of __________________________, 20__ at ______ a.m./p.m. in Courtroom No. _____, ________ Floor, Dauphin County Courthouse, Front and Market Streets, Harrisburg, PA. It is further ordered that an official search be conducted by the county office where the Petitioner resided within the past five (5) years no more than 48 hours prior to the scheduled hearing date. Proper certification from the Prothonotarys Office verifying that there are no judgments, decrees of record, or any other of like character against the Petitioner shall be submitted at the hearing. It is further ordered that a notice of said hearing shall be made by one (1) publication in both the Dauphin County Reporter and in a newspaper of general circulation in Dauphin County, PA. Such publication shall take place at least one (1) week prior to said hearing. Proof of publication shall be submitted prior to or at the hearing. If a parent is requesting that the name of a minor child be changed, the filing parent is directed to send a copy of the petition and this order to the other parent. IF THE OTHER PARENT DOES NOT ATTEND THE HEARING, PROOF THAT THE OTHER PARENT RECEIVED A COPY OF THE PETITION AND NOTIFICATION OF
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THE NAME CHANGE HEARING MUST BE SUBMITTED TO THE COURT AT THE HEARING.
BY THE COURT: __________________________________ JUDGE
DISTRIBUTION:
________________________________________________________________
Petitioners Name and Address
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Name: ________________________________________
(Name(s) of Parent(s) of Minor Child Who Wants to Change Childs Name)
Address: ______________________________________
(Address of Person Who Wants to Change His/Her Name)
City: _____________________, PA Zip: ____________ Phone: ________________________ Email: ________________________
IN RE: NAME CHANGE OF ______________________________
(NAME OF PARENT(S)
: IN THE COURT OF COMMON PLEAS : DAUPHIN COUNTY, PENNSYLVANIA : : : NO. ____________________ :
______________________________
(NAME OF MINOR CHILD)
PETITION FOR CHANGE OF NAME
TO THE HONORABLE JUDGES OF SAID COURT: The Petition of __________________________________________________________
(Name of Parent(s) of Minor Child)
represents: 1. Minor Child is ______________________________________, who
(Name of Person Who Wants to Change His/Her Name)
resides at ____________________________________________________________.
(Complete Address of Person Who Wants to Change His/Her Name)
2.
Minor Childs date of birth is: _____________________________.
(Minor Childs Date of Birth)
3. Minor Child has resided at the following addresses for the five (5) years previous to the filing of this Petition: ______________________________________________________________________
(Complete Addresses of all Places Person Who Wants to Change His/Her Name has Resided for the Past Five (5) Years)
______________________________________________________________________ _____________________________________________________________________.
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4.
Minor Child desires and intends to change his/her name to:
_____________________________________________________________________.
(What is the Name that the Person Wants the Court to Change His/Her Name To)
5.
Please state the names and addresses of the minor childs mother and father:
______________________________________________________________________
(List the Name and Address of the Childs Mother and Father)
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 6. Petitioner or Minor Child provides the following reasons for this request:
______________________________________________________________________
(State In Detail Why You Want to Change Your Name)
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
7.
The proposed change in Minor Childs name, if granted, will not be detrimental to
the interests of any other person and is not against public interest. 8. 9. The Petition is not filed to defraud creditors. WHEREFORE, Petitioner on Behalf of Minor Child requests the Court, pursuant
to the Act of December 16, 1982, P.L. 1309, No. 295 2, 54 Pa.C.S. 701, for the following: a. b. to fix a hearing on this Petition; to direct that notice be given on this Petition and hearing; and
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c.
to enter a decree changing the Minor Childs name from
_________________________________ to _____________________________.
(Complete Present Name) (Complete Proposed New Name)
________________________________ SIGNATURE OF PETITIONER
________________________________ Print Name of Petitioner
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VERIFICATION I/we, ________________________________________________, verify that the facts
(Name of Parent(s) of Minor Child)
set forth in the PETITION FOR CHANGE OF NAME are true and correct to the best of my/our knowledge, information and belief. I/we understand that the statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to authorities.
________________________ Date
____________________________________ Signature of Petitioner ____________________________________ Print Name of Petitioner
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IN RE: CHANGE OF NAME OF ______________________________
(PARENT(S) NAME)
: IN THE COURT OF COMMON PLEAS : DAUPHIN COUNTY, PENNSYLVANIA : : NO: _________________________ : :
______________________________
(NAME OF MINOR CHILD)
DECREE FOR CHANGE OF NAME
AND NOW, this _______ day of _____________ 20___, following a hearing on _____________________________ before this Court, and it having been determined that the requirements of 54 Pa.C.S.A. 701 have been satisfied, it is hereby ORDERED and DECREED that the name is of the hereby Minor changed Child, to
____________________________________
____________________________________ and that Minor Child, from this date forward, shall exclusively use and be known by the name of
________________________________________.
BY THE COURT:
__________________________________ JUDGE
DISTRIBUTION: ________________________________________________________________ Petitioners Name and Address
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