Petitioner's Name What is your CURRENT name? First, middle, last New Name What is your NEW or PROPOSED name? First, middle, last Mailing Address What is your Mailing Address? Street Address, City, State, Zip Code How long have you lived here? Ex. 5 years Reason for Change What is the REASON for the name change? Ex. "Name change after marriage" or "As part of a gender transition." Birth Name What was your Birth Name? First, middle, lastThis should be the same name as listed on your birth certificate. Date of Birth What is your Date of Birth? Birth Location What COUNTY were you born? County What CITY were you born? What STATE were you born? Father's Details What is your Father's name? First, middle, last Where does your Father reside? Street Address, City, State, Zip Code Mother's Details What is your Mother's name? First, middle, last Where does your Mother reside? Street Address, City, State, Zip Code Other Names Has your name EVER been legally changed in the past? Has your name EVER been legally changed in the past? YesNo Other Legal Name: First, middle, last Add another name? Add another name? YesNo Other Legal Name: First, middle, last Add another name? Add another name? YesNo Other Legal Name: First, middle, last Court Which COUNTY is this being filed? SelectAdamsAlcornAmiteAttalaBentonBolivarCalhounCarrollChickasawChoctawClaiborneClarkeClayCoahomaCopiahCovingtonDeSotoForrestFranklinGeorgeGreeneGrenadaHancockHarrisonHindsHolmesHumphreysIssaquenaItawambaJacksonJasperJeffersonJefferson DavisJonesKemperLafayetteLamarLauderdaleLawrenceLeakeLeeLefloreLincolnLowndesMadisonMarionMarshallMonroeMontgomeryNeshobaNewtonNoxubeeOktibbehaPanolaPearl RiverPerryPikePontotocPrentissQuitmanRankinScottSharkeySimpsonSmithStoneSunflowerTallahatchieTateTippahTishomingoTunicaUnionWalthallWarrenWashingtonWayneWebsterWilkinsonWinstonYalobushaYazooCounty This should be the same county where you reside. Notarization Required The name change petition is required to be NOTARIZED. The name change petition is required to be NOTARIZED. I understand It can also be signed by some court clerks depending on the county. Next Save Save and finish later
