________________________________________________________________________________
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF [COUNTY NAME]
COURT OF COMMON PLEAS
________________________________________________________________________________
IN RE: PETITION FOR CHANGE OF NAME
[CURRENT FULL LEGAL NAME],
Petitioner. No.: _______________
________________________________________________________________________________
PETITION FOR CHANGE OF NAME
________________________________________________________________________________
Petitioner [CURRENT FULL LEGAL NAME], appearing pro se, hereby files this
Petition for Change of Name pursuant to 54 Pa.C.S. Chapter 3, 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]
- Social Security Number: XXX-XX-[LAST 4 DIGITS]
- Current Address: [ADDRESS], [CITY], [COUNTY] County, Pennsylvania [ZIP]
- Petitioner has resided at the above address for [TIME PERIOD].
- Petitioner has resided in Pennsylvania 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 Pennsylvania
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 Protection From Abuse
(PFA) order or similar restraining order.
[ ] Petitioner has been subject to a PFA or 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]
PUBLICATION REQUIREMENT
- Petitioner understands that Pennsylvania law requires publication of
notice of this name change petition, and Petitioner will publish
notice in [NEWSPAPER NAME], a newspaper of general circulation in
[COUNTY] County.
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. Order that the Prothonotary shall make the change of name a matter
of public record;
d. 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], PA [ZIP CODE]
[PHONE NUMBER]
[EMAIL ADDRESS]
________________________________________________________________________________
VERIFICATION
________________________________________________________________________________
I, [YOUR FULL LEGAL NAME], being duly sworn according to law, 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 set forth
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 ___ day of __________, 20___.
________________________________
Notary Public
My Commission Expires: ______________
________________________________________________________________________________
PENNSYLVANIA NAME CHANGE GUIDE
________________________________________________________________________________
LEGAL AUTHORITY:
- 54 Pa.C.S. Chapter 3 (Change of Name Act)
ELIGIBILITY:
- Must be a resident of Pennsylvania
- 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 Prothonotary's Office in the county
where you reside:
- Filing fee: Approximately $50-150 (varies by county)
- Bring valid government-issued photo ID
- PUBLISH notice of the name change petition in a newspaper of
general circulation in your county:
- Must publish once per week for two consecutive weeks
- Publication cost: Approximately $50-150
- Some newspapers offer discounts for legal notices
- FILE proof of publication (affidavit from the newspaper) with
the Prothonotary
- ATTEND the court hearing (if required by your county)
- Some counties require a hearing; others do not
- Bring photo ID and proof of publication
- RECEIVE the court order granting the name change
- UPDATE your records:
- Social Security Administration
- Driver's license (PennDOT)
- Passport
- Bank accounts
- Employer records
- Insurance policies
- Voter registration
FINGERPRINTING REQUIREMENT:
Some counties require fingerprinting for a background check. Check
with your local Prothonotary's office.
FORMATTING REQUIREMENT (Pa.R.C.P. No. 204.1):
Every document filed with a Pennsylvania court must have a 3-inch (3") blank
top margin on the first page. Subsequent pages require a minimum 1-inch top
margin. Verify margins before filing.
CONFIDENTIAL INFORMATION FORM (Pa.R.C.P. No. 207.1 — Effective Jan. 1, 2022):
Do NOT include in this or any public court document:
• Social Security Numbers — use last 4 digits only, or submit separately on
AOPC Form 3 (Confidential Information Form)
• Financial account numbers — last 4 digits only
• Driver's license numbers — submit on AOPC Form 3
• Minor children's full dates of birth — submit on AOPC Form 3
File completed AOPC Form 3 with the Prothonotary/Clerk separately from this
filing. Download at: www.pacourts.us/forms/for-the-public
PENNSYLVANIA PROTHONOTARY OFFICES:
Philadelphia County:
- Prothonotary's Office
- City Hall, Room 286
- Philadelphia, PA 19107
- Phone: (215) 686-6650
Allegheny County (Pittsburgh):
- Prothonotary's Office
- 414 Grant Street, Room 109
- Pittsburgh, PA 15219
- Phone: (412) 350-5729
Montgomery County:
- Prothonotary's Office
- 2 E. Airy Street
- Norristown, PA 19401
- Phone: (610) 278-3360
Delaware County:
- Prothonotary's Office
- 201 W. Front Street
- Media, PA 19063
- Phone: (610) 891-4000
Chester County:
- Prothonotary's Office
- 2 N. High Street
- West Chester, PA 19380
- Phone: (610) 344-6300
IMPORTANT NOTES:
- If you have a criminal history, the court may deny your petition
or require additional hearings
- If you are changing a minor child's name, both parents must consent
or you must serve the other parent and obtain court approval
- If you have been subject to a Protection From Abuse order, you may
need to provide additional information to the court
- The entire process typically takes 4-8 weeks
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LEGAL DISCLAIMER
________________________________________________________________________________
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 Pennsylvania attorney if you have
questions about your specific situation.
Pennsylvania name change laws are subject to change. Verify current
requirements with the Pennsylvania Consolidated Statutes or a qualified
attorney.