________________________________________________________________________________
STATE OF MISSISSIPPI
[COUNTY] COUNTY
CHANCERY COURT
________________________________________________________________________________
IN RE: PETITION FOR CHANGE OF NAME
[CURRENT FULL LEGAL NAME],
Petitioner. Cause No.: _______________
________________________________________________________________________________
PETITION FOR CHANGE OF NAME
________________________________________________________________________________
Petitioner [CURRENT FULL LEGAL NAME], appearing pro se, hereby files this
Petition for Change of Name pursuant to Miss. Code Ann. § 21-37-1, and in
support thereof states as follows:
PETITIONER INFORMATION
- Current Full Legal Name: [CURRENT FULL LEGAL NAME]
- Requested New Name: [NEW FULL LEGAL NAME]
- Date of Birth: [DATE OF BIRTH]
- Place of Birth: [CITY], [STATE], [COUNTRY]
- Social Security Number: XXX-XX-[LAST 4 DIGITS]
- Current Address: [ADDRESS], [CITY], [COUNTY] County, Mississippi [ZIP]
- Petitioner has resided at the above address for [TIME PERIOD].
- Petitioner has resided in Mississippi for [TIME PERIOD].
REASON FOR NAME CHANGE
- Petitioner requests this name change for the following reason(s):
[STATE YOUR REASON FOR WANTING TO CHANGE YOUR NAME]
- Petitioner is NOT seeking this name change for any fraudulent or
illegal purpose.
- Petitioner is NOT seeking this name change to avoid creditors,
escape criminal prosecution, or evade any legal obligation.
BACKGROUND INFORMATION
- Petitioner's parents are:
- Father's Name: [NAME]
- Mother's Maiden Name: [NAME]
- If married, provide spouse information:
[ ] Not married
[ ] Spouse's Name: [NAME]
[ ] Date of Marriage: [DATE]
- Petitioner has the following minor children:
[ ] None
[ ] Children:
| Child's Name | Date of Birth | Age |
|---|---|---|
| [NAME] | [DOB] | [AGE] |
- Petitioner's occupation: [OCCUPATION]
- Petitioner's employer: [EMPLOYER NAME AND ADDRESS]
CRIMINAL HISTORY
- [ ] Petitioner has NEVER been convicted of a crime in Mississippi
or any other jurisdiction.
[ ] Petitioner has been convicted of the following crime(s):
- Offense: [NAME OF OFFENSE]
- Date: [DATE]
- Court: [COURT AND LOCATION]
- Disposition: [OUTCOME]
- [ ] Petitioner has NEVER been subject to a restraining order or
order of protection.
[ ] Petitioner has been subject to a restraining order:
- Court: [COURT]
- Date: [DATE]
- Status: [EXPIRED/DISMISSED/ACTIVE]
BANKRUPTCY AND FINANCIAL MATTERS
- [ ] Petitioner has NEVER filed for bankruptcy.
[ ] Petitioner filed for bankruptcy on [DATE] in [COURT].
- [ ] Petitioner is NOT currently involved in any legal proceedings.
[ ] Petitioner is involved in the following legal proceedings:
[DESCRIBE ANY PENDING LAWSUITS, DIVORCES, OR OTHER LEGAL MATTERS]
PRAYER FOR RELIEF
WHEREFORE, Petitioner respectfully requests that this Honorable Court:
a. Grant the Petition for Change of Name;
b. Order that Petitioner's name be changed from [CURRENT NAME] to
[NEW NAME];
c. Grant such other and further relief as the Court deems just and proper.
________________________________
[YOUR FULL LEGAL NAME]
Petitioner (Signature)
________________________________
[YOUR FULL LEGAL NAME - PRINTED]
Petitioner (Print Name)
[ADDRESS]
[CITY], MS [ZIP CODE]
[PHONE NUMBER]
[EMAIL ADDRESS]
________________________________________________________________________________
VERIFICATION
________________________________________________________________________________
STATE OF MISSISSIPPI)
ss.:
COUNTY OF __________)
I, [YOUR FULL LEGAL NAME], being first duly sworn, depose and say that I am
the Petitioner in this matter, that I have read the foregoing Petition for
Change of Name, and that the facts stated therein are true and correct to
the best of my knowledge, information, and belief.
________________________________
[YOUR FULL LEGAL NAME]
Petitioner
SWORN TO AND SUBSCRIBED before me, this the ___ day of __________, 20___.
________________________________
Notary Public
My Commission Expires: ______________
________________________________________________________________________________
MISSISSIPPI NAME CHANGE GUIDE
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LEGAL AUTHORITY:
- Miss. Code Ann. § 21-37-1 (Change of Name)
- Miss. Code Ann. § 93-17-1 et seq. (Minor Name Changes)
ELIGIBILITY:
- Must be a resident of Mississippi
- Must be at least 18 years old (minors require parental consent)
- Must not be changing name for fraudulent or illegal purposes
FILING PROCEDURE:
- COMPLETE the Petition for Change of Name
- FILE the Petition with the Chancery Court in your county:
- Filing fee: Approximately $100-150
- File in the county where you reside
- ATTEND the court hearing (if required)
- Most Mississippi counties require a hearing
- Bring valid photo identification
- RECEIVE the court order granting the name change
- PUBLISH notice (if required by the court)
- Some courts require publication in a local newspaper
- Publication cost: Approximately $50-100
MISSISSIPPI CHANCERY COURTS:
File in the Chancery Court of the county where you reside.
HINDS COUNTY (Jackson):
- Hinds County Chancery Court
- 316 South President Street
- Jackson, MS 39201
- Phone: (601) 968-6588
HARRISON COUNTY (Gulfport):
- Harrison County Chancery Court
- 1801 23rd Avenue
- Gulfport, MS 39501
- Phone: (228) 865-4000
RANKIN COUNTY (Brandon):
- Rankin County Chancery Court
- 2190 Highway 468 West
- Brandon, MS 39042
- Phone: (601) 824-1450
DE SOTO COUNTY (Southaven):
- De Soto County Chancery Court
- 2535 Highway 51 South
- Hernando, MS 38632
- Phone: (662) 449-1900
MADISON COUNTY (Canton):
- Madison County Chancery Court
- 128 West North Street
- Canton, MS 39046
- Phone: (601) 859-1301
UPDATING YOUR RECORDS:
After receiving the court order, update:
- Social Security Administration
- Mississippi Department of Public Safety (driver's license)
- U.S. Passport
- Bank accounts
- Employer records
- Insurance policies
- Voter registration
- Professional licenses
IMPORTANT NOTES:
- If you have a criminal history, the court may require additional
information or deny your application
- If changing a minor child's name, both parents must consent or
you must serve the other parent and obtain court approval
- The entire process typically takes 4-8 weeks
- Mississippi does not require publication for adult name changes
unless specifically ordered by the court
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LEGAL DISCLAIMER
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This document is provided for informational purposes only and does not
constitute legal advice. Name change procedures may vary by county.
You should consult with a licensed Mississippi attorney if you have
questions about your specific situation.
Mississippi name change laws are subject to change. Verify current
requirements with the Mississippi Code or a qualified attorney.