IN THE DISTRICT COURT, JOHNSON COUNTY, KANSAS
CIVIL COURT DEPARTMENT
In the Matter of the Petition of: )
)
[Name] ) Case No. ________________
)
To Change His/Her Name. ) Div. No. ________________
_____________________________ )
Pursuant to Chapter 60
PETITION FOR CHANGE OF NAME
Petitioner states:
1. Petitioner has been a resident of Kansas for more than sixty (60) days before filing this petition.
2. Petitioner’s birth certificate shows his/her name as
_______________________________________________.
3. Petitioner desires to have his/her legal name changed to _______________________.
4. The Petitioner desires the name change because______________________________
_______________________________________________________________________.
5. This Petition is not made for the purpose of avoiding any debts, obligations or legal process nor will it result in prejudice to any person.
6. Petitioner’s best interests are served by the requested change in name.
WHEREFORE, Petitioner prays this Court set this matter for hearing, order services by
Publication, certified mail, or, if appropriate, waive any requirements for service; issue an order
changing Petitioner’s name from____________________ _________________________ to
_________________________ __________________and for such other further relief as the Court deems appropriate under the circumstances.
_____________________________________
Petitioner, Pro Se
[Address]
[City, State, Zip]
[Telephone]
VERIFICATION
STATE OF KANSAS )
) ss:
COUNTY OF JOHNSON )
_____________________________[Petitioner’s Name], of lawful age, being first duly sworn, on his/her oath, states:
He/She is the Petitioner in the above-captioned matter; that he/she has read the above and
foregoing Petition and the statements, allegations, and matters contained herein are true and correct.
_______________________________
Petitioner, Pro Se
SUBSCRIBED AND SWORN to before me on this ____ day of ___________, 2_____.
_______________________________
Notary Public
My Appointment Expires:
_____________________
