Petitioner's Name What is your Current Name? First, middle, last New Name What is your NEW or REQUESTED Name? First, middle, last Former Names or Aliases Do you have any FORMER NAMES or ALIASES that you've used in the past? Do you have any FORMER NAMES or ALIASES that you've used in the past? YesNo Enter any Former Names: Mailing Address What is your Street Address? (only) What is your City, State? What is your Zip Code? Former Addresses Have you lived at the SAME ADDRESS for the last 7 years? Have you lived at the SAME ADDRESS for the last 7 years? YesNo 1st Former Address: Street Address, City, State, Zip Code Add another Address? Add another Address? YesNo 2nd Former Address Street Address, City, State, Zip Code Add another Address? Add another Address? YesNo 3rd Former Address Street Address, City, State, Zip Code Date of Birth What is your Current Age? (# years old) Years Old What is your Date of Birth? Birthplace What is your Birthplace? (city, state, country) Ex. Charleston, South Carolina, USA Birth Certificate What is your FULL NAME on your Birth Certificate? First, middle, last Gender What is your Gender? SelectMaleFemale Ethnicity / Race What is your Ethnicity or Race? SelectWhiteAsianBlack or African AmericanHispanic or LatinoAmerican Indian or Alaska NativeNative Hawaiian or Other Pacific IslanderOther Contact Details The court uses this as a contact method. What is your E-Mail? What is your Phone Number? Social Security Number The court uses this for identification purposes. For added security, if you would prefer to handwrite this into the application rather than entering here, you can do so. What is your Social Security Number? County Which COUNTY is this being filed? SELECTABBEVILLEAIKENALLENDALEANDERSONBAMBERGBARNWELLBEAUFORTBERKELEYCALHOUNCHARLESTONCHEROKEECHESTERCHESTERFIELDCLARENDONCOLLETONDARLINGTONDILLONDORCHESTEREDGEFIELDFAIRFIELDFLORENCEGEORGETOWNGREENVILLEGREENWOODHAMPTONHORRYJASPERKERSHAWLANCASTERLAURENSLEELEXINGTONMARIONMARLBOROMCCORMICKNEWBERRYOCONEEORANGEBURGPICKENSRICHLANDSALUDASPARTANBURGSUMTERUNIONWILLIAMSBURGYORKCOUNTY Next Save Save and finish later
