The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

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Here is the text we could read:

PETITION FOR
CHANGE OF NAME

DOCKET NUMBER

Trial Court of Massachusetts
Juvenile Court Department

DIVISION

1. Name of Petitioner:

2. The child's current legal name (if different from petitioner) is:

3. Child's date of birth: Child's SSN:

Child's place of birth:

Child's Address:

4. What is your relationship to the child?

5. Child's Parents: Mother Father

Name:

Address:

Telephone:

6. Reason for name change:

_______________________________________________________________

_____________________________________________________________________________________

7. Has the child ever changed his/her name prior to this petition? Yes No If yes, please explain:

_____________________________________________________________________________________

_____________________________________________________________________________________
(Attach a copy of the Name Change Judgment or Decree)

8. A copy of the child's birth certificate is attached.

WHEREFORE, the Petitioner requests that the child's name be changed as follows:

Name at present:

To be changed to:

Petitioner requests the Court to waive public notice of this petition. As reasons the petitioner states:
_____________________________________________________________________________________

_____________________________________________________________________________________

Mother assents to the petition to change the child's name. (See page 2)

Father assents to the petition to change the child's name. (See page 2)

Date:

JV-124 (Rev. 11/05/2018)

(Signature of Petitioner)

(Address)

Telephone No.

Page 1 of 2

PARENTAL ASSENT

I, , mother of the minor child hereby assent to the granting of the

petition to change the child's name to .

Date:

Then personally appeared before me the above named and

affirmed under penalties of perjury that the foregoing is her free act and deed this day of

, 20 .

Notary Public:

My Commission Expires:

I, , father of the minor child hereby assent to the granting of the

petition to change the child's name to .

Signature

Then personally appeared before me the above named and

affirmed under penalties of perjury that the foregoing is his free act and deed this day of

, 20 .

Notary Public:

My Commission Expires:

JV-124 (Rev. 11/05/2018)

Page 2 of 2

Petition for Change of Name

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Massachusetts state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.mass.gov (2023-03)
Page(s): 2
Fields(s): 54
Average fields per page: 27
Reading Level: Grade 6
LIST Grouping(s): GO-00-00-00-00.

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

transaction_page_set_date_field was transaction[0].#pageSet[0].Page1[0].Date[0].TextField2[0] (0.61 conf)
transaction_page_set_field was transaction[0].#pageSet[0].Page1[0].Signature[0].TextField2[0] (0.42 conf)
transaction_page_case was transaction[0].Page1[0].case[0] (0.37 conf)
transaction_data_drop_list was transaction[0].Page1[0].DataDropDownList[0] (0.36 conf)
transaction_page_petitioner was transaction[0].Page1[0].Petitioner[0] (0.38 conf)
transaction_page_child_name was transaction[0].Page1[0].ChildName[0] (0.37 conf)
transaction_page_child_info_b was transaction[0].Page1[0].Child_Info[0].Child_DOB[0] (0.33 conf)
transaction_page_child_info_n was transaction[0].Page1[0].Child_Info[0].Child_SSN[0] (0.36 conf)
transaction_page_child_info_po was transaction[0].Page1[0].Child_Info[0].Child_POB[0] (0.37 conf)
page_child_info_address__1 was transaction[0].Page1[0].Child_Info[0].Child_Address1[0] (0.36 conf)
page_child_info_address__2 was transaction[0].Page1[0].Child_Info[0].Child_Address2[0] (0.36 conf)
transaction_page_relationship was transaction[0].Page1[0].Relationship[0] (0.38 conf)
parents_mother_name was transaction[0].Page1[0].Parents[0].Mother_Name[0] (0.39 conf)
page_parents_name was transaction[0].Page1[0].Parents[0].Father_Name[0] (0.37 conf)
parents_mother_address__1 was transaction[0].Page1[0].Parents[0].Mother_Address1[0] (0.39 conf)
transaction_parents_address__1 was transaction[0].Page1[0].Parents[0].Father_Address1[0] (0.37 conf)
parents_mother_address__2 was transaction[0].Page1[0].Parents[0].Mother_Address2[0] (0.39 conf)
transaction_parents_address__2 was transaction[0].Page1[0].Parents[0].Father_Address2[0] (0.37 conf)
transaction_page_mother_phone was transaction[0].Page1[0].Parents[0].Mother_PhoneNum[0] (0.37 conf)
transaction_page_father_phone was transaction[0].Page1[0].Parents[0].Father_PhoneNum[0] (0.38 conf)
transaction_page_reason was transaction[0].Page1[0].Reason[0] (0.38 conf)
transaction_yes_check_box was transaction[0].Page1[0].#subform[2].Yes_CheckBox1[0] (0.41 conf)
transaction_page_check_box__1 was transaction[0].Page1[0].#subform[2].No_CheckBox1[0] (0.41 conf)
transaction_page_petition was transaction[0].Page1[0].Previous_Petition[0] (0.41 conf)
page_name_present was transaction[0].Page1[0].Name[0].Present_Name[0] (0.41 conf)
transaction_page_name_new was transaction[0].Page1[0].Name[0].New_Name[0] (0.35 conf)
transaction_check_box was transaction[0].Page1[0].Petitioner_CheckBox1[0] (0.39 conf)
transaction_page_notice was transaction[0].Page1[0].Notice[0] (0.38 conf)
transaction_parental_check_box was transaction[0].Page1[0].Parental_Assent[0].Mother_CheckBox1[0] (0.40 conf)
transaction_page_check_box__2 was transaction[0].Page1[0].Parental_Assent[0].Father_CheckBox1[0] (0.39 conf)
page_name_address__1 was transaction[0].Page1[0].Name_Address[0].Address11[0] (0.37 conf)
page_name_address__2 was transaction[0].Page1[0].Name_Address[0].Address12[0] (0.37 conf)
page_name_address__3 was transaction[0].Page1[0].Name_Address[0].Address13[0] (0.37 conf)
transaction_page_address_phone was transaction[0].Page1[0].Name_Address[0].PhoneNum[0] (0.39 conf)
transaction_set_date_field__1 was transaction[0].#pageSet[0].Page2[0].UntitledSubform[0].Date[0].TextField2[0] (0.42 conf)
page_set_mother_field was transaction[0].#pageSet[0].Page2[0].UntitledSubform[0].Mother[0].TextField2[0] (0.42 conf)
transaction_set_mother__1 was transaction[0].#pageSet[0].Page2[0].UntitledSubform[0].Notary_Mother[0].Notary1[0] (0.41 conf)
transaction_set_mother__2 was transaction[0].#pageSet[0].Page2[0].UntitledSubform[0].Notary_Mother[0].Commission1[0] (0.41 conf)
transaction_set_date_field__2 was transaction[0].#pageSet[0].Page2[0].UntitledSubform[0].Date[1].TextField2[0] (0.42 conf)
transaction_set_father_field was transaction[0].#pageSet[0].Page2[0].UntitledSubform[0].Father[0].TextField2[0] (0.42 conf)
transaction_set_father was transaction[0].#pageSet[0].Page2[0].UntitledSubform[0].Notary_Father[0].Notary2[0] (0.41 conf)
transaction_set_commission was transaction[0].#pageSet[0].Page2[0].UntitledSubform[0].Notary_Father[0].Commission2[0] (0.41 conf)
transaction_page_mother_name__1 was transaction[0].Page2[0].Mother_Name[0] (0.38 conf)
transaction_page_new_name__1 was transaction[0].Page2[0].Child_New_Name1[0] (0.37 conf)
transaction_page_mother_name__2 was transaction[0].Page2[0].Mother_Name2[0] (0.38 conf)
transaction_page_day__1 was transaction[0].Page2[0].Day1[0] (0.38 conf)
transaction_page_month__1 was transaction[0].Page2[0].Month1[0] (0.38 conf)
transaction_page_year__1 was transaction[0].Page2[0].Year1[0] (0.38 conf)
transaction_page_father was transaction[0].Page2[0].Father[0] (0.38 conf)
transaction_page_new_name__2 was transaction[0].Page2[0].Child_New_Name2[0] (0.37 conf)
transaction_page_father_name was transaction[0].Page2[0].Father_Name2[0] (0.35 conf)
transaction_page_day__2 was transaction[0].Page2[0].Day2[0] (0.38 conf)
transaction_page_month__2 was transaction[0].Page2[0].Month2[0] (0.38 conf)
transaction_page_year__2 was transaction[0].Page2[0].Year2[0] (0.38 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Petition for Change of Name

About This Form:

Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02