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STATE OF MICHIGAN

JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY

PETITION TO CHANGE NAME

CASE NO. and JUDGE

Court address

Court telephone no.

Note: This petition must be accompanied by a notice of hearing prepared for publication under MCR 3.613 (see PC 50). Every
person 22 years of age or older who is requesting a name change must have a criminal background check. For details, go to
michiganlegalhelp.org.

In the matter of

Present first, middle, and last name(s) (type or print)

Petitioner’s name, address, and telephone no.

Petitioner’s attorney, bar no., address, and telephone no.

1. An action within the jurisdiction of the family division of circuit court involving the family or family members of

person(s) named above has/have been previously filed in

Case Number

remains

and

is no longer

pending.

, was assigned to Judge

2. The name change is for

and

(Attach letters of guardianship.)

spouse.
minor child(ren), of whom the petitioner has legal custody. (For a minor 14 years or older, written consent is required. See
form PC 51b.)

a. a married person who wishes to also include a name change for his/her

b. an adult.
c. a minor, whose natural or adopted parents are

Parent

Deceased

Both parents are deceased. The guardian is

Parent

Name

Court,

Deceased

3. The name change is for the following reason:

4. The name change is not sought for any fraudulent intent.

5. The following person(s) seeking a name change has/have a criminal record:

6. Each person for whom a name change is sought has been a resident of the county for at least one year.

Approved, SCAO
Form PC 51, Rev. 4/21
MCL 333.2872, MCL 711.1, MCR 3.613
Page 1 of 3

PCS Code: NAMTCS Code: PNCFor help filling out this form, go to michiganlegalhelp.org

Petitioner

Spouse

Minor child

Name

Petition to Change Name
Page 2 of 3

(4/21)

Case No.

Note: Skip item 7 if the noncustodial parent consents to the name change or if there is not a noncustodial parent.

7. I have legal custody of the minor.

a support order has been entered, and the noncustodial parent has failed to substantially comply with the

a. The noncustodial parent has had the ability to visit, contact, or communicate with the child and has regularly and

substantially failed or neglected to do so for a period of two years or more before the filing of this petition and
either:

order for a period of two years or more before the filing of this petition; or

a support order has not been entered and the noncustodial parent, having the ability to support or assist in
supporting the child, has failed or neglected to provide regular and substantial support for two years or more
before the filing of this petition.

b. The noncustodial parent has been convicted of child abuse (MCL 750.136b), criminal sexual conduct (MCL 750.520b,
750.520c, 750.520d, or 750.520e), or assault with intent to commit criminal sexual conduct (MCL 750.520g) and the child
or a sibling of the child was the victim. (Attach judgment of sentence.)

(MCL 750.317). (Attach judgment of sentence.)
d. The last known address of the noncustodial parent is:

.
The noncustodial parent is not living at the above address, and I have taken the following steps to locate him/her:

c. The noncustodial parent has been convicted of first degree murder (MCL 750.316) or second degree murder

8. I request the following name change(s): (Type or print first name, middle name, and last name.)

FROM

DATE OF BIRTH

Put DOB in Ref. No. row 10 on MC 97a.

Put DOB in Ref. No. row 11 on MC 97a.

Put DOB in Ref. No. row 12 on MC 97a.

Put DOB in Ref. No. row 13 on MC 97a.

Put DOB in Ref. No. row 14 on MC 97a.

Put DOB in Ref. No. row 15 on MC 97a.

Put DOB in Ref. No. row 16 on MC 97a.

If you want a new live birth certificate, check item 9. A special order is not needed if you only want to add the changed name(s) to the original certificate(s).

9. I request the court to order the State Registrar to create a new live birth certificate that does not disclose the name of

at birth and to seal the original certificate.

I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best
of my information, knowledge, and belief.

Date

Petitioner signature

Petition to Change Name
Page 3 of 3

(4/21)

SIGNATURE OF PARENT/GUARDIAN FOR MINOR

Case No.

Date

Signature

Name (type or print)

Address

City, state, zip

Date

Signature

Name (type or print)

Attorney signature

Telephone no.

City, state, zip

Telephone no.

CONSENT BY SPOUSE OF PETITIONER

If the petition is filed for a spouse, this consent must be signed by the spouse of the petitioner.

I am the spouse of the petitioner and consent to the granting of this petition to change my name.

Attorney name (type or print)

Bar no.

City, state, zip

Telephone no.

Date

Signature

Name (type or print)

Address

City, state, zip

Address

PC 51, Petition to Change Name

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan 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.courts.michigan.gov/name-change (2023-03)
Page(s): 3
Fields(s): 80
Average fields per page: 26
Reading Level: Grade 7
LIST Grouping(s): FA-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

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.

stat_e_n_l_county was STATE OF MICHIGAN JUDICIAL CIRCUIT FAMILY DIVISION COUNTY (0.64 conf)
matter was In the matter of (0.33 conf)
petitioners_name_address was Petitioners name address and telephone no (0.40 conf)
petitioners_attorney_address was Petitioners attorney bar no address and telephone no (0.52 conf)
action_division_involving was 1 An action within the jurisdiction of the family division of circuit court involving the family or family members of (0.43 conf)
named_previously_filed was persons named above hashave been previously filed in (0.39 conf)
case_number was Case Number (0.41 conf)
assigned_judge was was assigned to Judge (0.41 conf)
remains was remains (0.32 conf)
longer was is no longer (0.37 conf)
person_wishes_also_include was a a married person who wishes to also include a name change for hisher (0.41 conf)
b_adult was b an adult (0.39 conf)
minor_whose_natural_adopted was c a minor whose natural or adopted parents are (0.42 conf)
spouse__1 was spouse (0.35 conf)
custody_consent_required was minor children of whom the petitioner has legal custody For a minor 14 years or older written consent is required See (0.44 conf)
parent was Parent (0.35 conf)
deceased__1 was Deceased (0.37 conf)
and was and (0.41 conf)
deceased__2 was Deceased_2 (0.37 conf)
parents_deceased_guardian was Both parents are deceased The guardian is (0.36 conf)
users1_name was Name (1.00 conf)
name_change_following_reason was 3 The name change is for the following reason (0.30 conf)
following_seeking_change was 5 The following persons seeking a name change hashave a criminal record (0.39 conf)
text__1 was Text1 (0.35 conf)
judge was Judge (0.39 conf)
court_address was court address (0.42 conf)
text__2 was Text3 (0.35 conf)
text__3 was Text4 (0.35 conf)
legal_custody_minor was 7 I have legal custody of the minor (0.41 conf)
parent_contact_communicate was a The noncustodial parent has had the ability to visit contact or communicate with the child and has regularly and (0.32 conf)
support_failed_substantially was a support order has been entered and the noncustodial parent has failed to substantially comply with the (0.31 conf)
support_ability_assist was a support order has not been entered and the noncustodial parent having the ability to support or assist in (0.37 conf)
child_abuse_criminal_sexual was b The noncustodial parent has been convicted of child abuse MCL 750136b criminal sexual conduct MCL 750520b (0.53 conf)
parent_convicted_first_second was c The noncustodial parent has been convicted of first degree murder MCL 750316 or second degree murder (0.45 conf)
undefined was undefined (0.38 conf)
last_address_parent was d The last known address of the noncustodial parent is (0.38 conf)
parent_address_taken was The noncustodial parent is not living at the above address and I have taken the following steps to locate himher (0.36 conf)
petitioner was TOPetitioner (0.52 conf)
spouse__2 was TOSpouse (0.54 conf)
minor_child__1 was TOMinor child (0.46 conf)
minor_child__2 was TOMinor child_2 (0.47 conf)
minor_child__3 was TOMinor child_3 (0.47 conf)
minor_child__4 was TOMinor child_4 (0.47 conf)
minor_child__5 was TOMinor child_5 (0.47 conf)
request_order_state_new was 9 I request the court to order the State Registrar to create a new live birth certificate that does not disclose the name of (0.48 conf)
name was Name_2 (0.30 conf)
information_knowledge_belief was of my information knowledge and belief (0.30 conf)
text__4 was Text5 (0.35 conf)
text__5 was Text6 (0.35 conf)
text__6 was Text7 (0.35 conf)
text__7 was Text8 (0.35 conf)
text__8 was Text9 (0.35 conf)
text__9 was Text10 (0.35 conf)
text__10 was Text11 (0.35 conf)
text__11 was Text12 (0.35 conf)
text__12 was Text13 (0.35 conf)
signature_date__1 was Date (1.00 conf)
signature_date__2 was Date_2 (1.00 conf)
name_type_print__1 was Name type or print (0.45 conf)
name_type_print__2 was Name type or print_2 (0.40 conf)
users1_address_line_one was Address (1.00 conf)
address__1 was Address_2 (0.35 conf)
users1_address_line_two was City state zip (1.00 conf)
telephone__1 was Telephone no (0.44 conf)
city_state_zip__1 was City state zip_2 (0.35 conf)
telephone__2 was Telephone no_2 (0.45 conf)
signature_date__3 was Date_3 (1.00 conf)
name_type_print__3 was Name type or print_3 (0.40 conf)
attorney_name_type_print was Attorney name type or print (0.50 conf)
bar was Bar no (0.41 conf)
address__2 was Address_3 (0.35 conf)
city_state_zip__2 was City state zip_3 (0.35 conf)
telephone__3 was Telephone no_3 (0.45 conf)
address__3 was Address_4 (0.35 conf)
city_state_zip__3 was City state zip_4 (0.35 conf)
telephone__4 was Telephone no_4 (0.45 conf)
text__13 was Text14 (0.35 conf)
text__14 was Text15 (0.35 conf)
text__15 was Text16 (0.35 conf)
text__16 was Text17 (0.35 conf)

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

PC 51, Petition to Change Name

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

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