PS–12

8/08

Request to Change Name
(For An Adult)

Case Number: (the clerk fills this in)

In the Probate Court of (county):__________________________________________ County, Alabama

Your current name:

first  

middle  

last

To ask the court to change your name, you must fill out this form, and:

•  Attach a certified copy of your birth certificate and a copy of your photo ID, and
•  File your form and attachments in the same county where you live.

I declare that the following information is true:
q My current name is:                                                                                                                                                                

first 

middle

last

street 

w My address is:                                                                                                                                                                            
city
e My phone numbers are (home):                                                            (work):                                                                      
r My date of birth is (mm/dd/yyyy):                                                                                                                                           
t My name at birth was:                                                                                                                                                             

state

zip

first 

middle

last

y I am an adult (19 or older), of sound mind, and live in (name of Alabama county):                                                          
u The attached copy of my photo ID is my (check one):   Driver’s license, #                                                                
 Non-driver’s photo, ID #:                                                  
i I ask the court to change my name because (explain why you want to change your name):                                           
                                                                                                                                                                                                        

                                                                                                                                                                                                        
o I want my new name to be:                                                                                                                                                   

first 

middle

last

a I also declare:

• 
• 

• 
• 

I am not now facing criminal charges, nor am I involved in any other court case.
I have never been convicted of a criminal sex offense (as defined in Alabama Code § 15-20-21),
a crime of moral turpitude, or a felony.
I am not asking to change my name to avoid paying my debts or to commit fraud.
I swear that all of the information I have provided above is complete and accurate.

I ask the court to grant this request and to issue an order changing my name.

Sign below in front of a notary:

                                                                                                                         Date:                                                                       

Notary fills out below—
Sworn to and subscribed before me, the undersigned authority,

By (Print name of notary):                                                                                                     

On this date:                                                                                                                              

(Notary’s seal here)

                                                                                                                                                  
Date notary’s commission expires

   Notary signs here

    /     /

Rev. 8/08

 2008 Alabama State Bar