Full Text
Page 1 of 3 Petition to Change Name of Adult — Updated May 29, 2024 SUPERIOR COURT OF COLUMBIA COUNTY STATE OF GEORGIA In re the Name Change of: , Petitioner. Civil Action Case Number PETITION TO CHANGE NAME OF ADULT My name is and I am representing myself in this petition. In support of my case, I state the following: 1. I reside in COLUMBIA County, Georgia. Therefore, jurisdiction and venue are proper in this Court. 2. I was born on : [Check and complete only one of the following.] in County, State of , U.S.A. outside the United States, in . 3. I want to change my name from to . 4. [Explain here why you want to change your name.] The reasons for this name change are as follows: ---PAGE BREAK--- Page 2 of 3 Petition to Change Name of Adult — Updated May 29, 2024 5. I do not intend to use this name change to fraudulently deprive anyone of any right under the law. THEREFORE, I ask: That my name be changed as provided in Paragraph 3 above; That notice of this Petition be served as provided by law. Dated: Petitioner, Pro se (Signature) Name: Address: Email: IF YOU DO NOT HAVE AN EMAIL ADDRESS, FILL OUT A CERTIFICATE OF NO EMAIL ADDRESS Telephone No.: ---PAGE BREAK--- Page 3 of 3 Petition to Change Name of Adult — Updated May 29, 2024 SUPERIOR COURT OF COLUMBIA COUNTY STATE OF GEORGIA , Petitioner, v. , Respondent. Civil Action Case Number VERIFICATION I, , personally appeared before the undersigned notary public and, being duly sworn, state that the facts stated in the foregoing Petition are true and correct. This day of , (year) Signature Name: Email: IF YOU DO NOT HAVE AN EMAIL ADDRESS, FILL OUT A CERTIFICATE OF NO EMAIL ADDRESS Telephone No.: Sworn to before me this day of , 20 . Notary Public