Petitioner's Name What is your (current) First Name? What is your (current) Middle Name? What is your (current) Last Name? New Name What is your (new) First Name? What is your (new) Middle Name? What is your (new) Last Name? Ethnicity This is required by the court. What is your Ethnicity or Race? SelectWhiteBlack or African AmericanAsianAmerican Indian or Alaska NativeNative Hawaiian or Other Pacific IslanderOther Sex Offender Are you required to REGISTER as a SEX OFFENDER? Are you required to REGISTER as a SEX OFFENDER? YesNo Mailing Address Are you part of the Attorney General Confidentiality Program? Are you part of the Attorney General Confidentiality Program? YesNo If enrolled, the Attorney General Confidentiality Program provides a substitute post office box address and mail forwarding service. This helps prevent your actual address from being revealed in state government documents and files while still allowing you to receive and send mail. Confirm that you are part of the Attorney General's Confidentiality Program Confirm that you are part of the Attorney General's Confidentiality Program I confirm. What is your Street Address? What is your City? What is your State? What is your Zip Code? Country of Residency Which COUNTRY do you currently reside in? Reason for Change What is the REASON for the Name Change? Ex. "Name change after marriage" or "As part of a gender change." Criminal Offenses (Committed) Have you ever been charged with a Class A or B Misdemeanor or a Felony? Have you ever been charged with a Class A or B Misdemeanor or a Felony? YesNo Misdemeanor Have you ever committed a MISDEMEANOR? Have you ever committed a MISDEMEANOR? YesNo Misdemeanor Description: Ex. "Drunk driving (DUI)" Court County: Ex. "Brewster County" Type of Court: Type of Court: District CourtCounty Court Court Number: Case Number: Add another Misdemeanor? Add another Misdemeanor? YesNo Misdemeanor Description: Court County: Type of Court: Type of Court: District CourtCounty Court Court Number: Case Number: Add another Misdemeanor? Add another Misdemeanor? YesNo Misdemeanor Description: Court County: Type of Court: Type of Court: County CourtDistrict Court Court Number: Case Number: Add another Misdemeanor? Add another Misdemeanor? YesNo Misdemeanor Description: Court County: Court Number: Type of Court: Type of Court: District CourtCounty Court Case Number: Add another Misdemeanor? Add another Misdemeanor? YesNo Misdemeanor Description: Case Number: Court County: Court Number: Type of Court: Type of Court: District CourtCounty Court Felony Have you ever been convicted of a Felony? Have you ever been convicted of a Felony? YesNo Felony Description: Felony Case Number: County that Processed the Felony: Ex. Brewster County Court Number that Processed the Felony: Court that Processed the Felony: Court that Processed the Felony: District CourtCounty Court Add another Felony? Add another Felony? YesNo Felony Description: Felony Case Number: County that Processed the Felony: Court Number that Processed the Felony: Court that Processed the Felony: Court that Processed the Felony: District CourtCounty Court Add another Felony? Add another Felony? YesNo Felony Description: Felony Case Number: County that Processed the Felony: Court Number that Processed the Felony: Court that Processed the Felony: Court that Processed the Felony: County CourtDistrict Court Add another Felony? Add another Felony? YesNo Felony Description: Felony Case Number: County that Processed the Felony: Court Number that Processed the Felony: Court that Processed the Felony: Court that Processed the Felony: County CourtDistrict Court Add another Felony? Add another Felony? YesNo Felony Description: Felony Case Number: County that Processed the Felony: Court Number that Processed the Felony: Court that Processed the Felony: Court that Processed the Felony: County CourtDistrict Court Driver's License Have you had a Driver's License in the last 10 years? Have you had a Driver's License in the last 10 years? YesNo Driver's Lisence Number: Driver's License State: Add another Driver's License? Add another Driver's License? YesNo Driver's License Number: Driver's License State: Add another Driver's License? Add another Driver's License? YesNo Driver's License Number: Driver's License State: Add another Driver's License? Add another Driver's License? YesNo Driver's License Number: Driver's License State: Birthplace What CITY were you born? What STATE were you born? What COUNTY were you born? County What COUNTRY were you born? Date of Birth What is your Date of Birth? Gender What GENDER is listed on your Birth Certificate? What GENDER is listed on your Birth Certificate? MaleFemale CONFIRM your Gender: CONFIRM your Gender: MaleFemale Order Changing Name Form You will now start completing the Order Changing Name Form: You will now start completing the Order Changing Name Form: I understand. This form may ask for some of the same or similar information that has already been entered. Sex Offender Are you required to register as a Sex Offender? Are you required to register as a Sex Offender? YesNo Contact Details This is ONLY used by the court. What is your E-Mail? What is your Phone Number? Fax Number If you have a fax number, the court will send notices through this method in addition to the mail. Do you have a Fax Number? Do you have a Fax Number? YesNo What is your Fax Number? Social Security Number (SSN) Do you have a Social Security Number? Do you have a Social Security Number? YesNo Confirm you DO NOT have a Social Security Number: Confirm you DO NOT have a Social Security Number: I confirm. What is your Social Security Number? This is required but can also be added at a later time if you prefer. Confidentiality Program Are you part of the Office of the Attorney General's Confidentiality Program? Are you part of the Office of the Attorney General's Confidentiality Program? YesNo If enrolled, the Attorney General Confidentiality Program provides a substitute post office box address and mail forwarding service. This helps prevent your actual address from being revealed in state government documents and files while still allowing you to receive and send mail. FBI or SID Number Do you have an FBI or SID Number? (check one) Do you have an FBI or SID Number? (check one) NoI have an FBI Number.I have a State Identification Number (SID). What is your FBI Number? What is your State Identification Number (SID)? Page Title Please enter a page description. Have you EVER been charged with a Class A or Class B Misdemeanor or Felony? Have you EVER been charged with a Class A or Class B Misdemeanor or Felony? YesNo Confirm if you have EVER been convicted of a Felony (only)? Confirm if you have EVER been convicted of a Felony (only)? NoI have been convicted of a felony and pardoned.Have been convicted of a felony and at least 2 years have passed since a discharge has been granted.Yes, I have been convicted of a felony and changing my name to the primary name used in the criminal offense against me. Describe the Offense: What was the Case Number? Which County and State charged you? What was the Court Number? What was the Court you were convicted? What was the Court you were convicted? District CourtCounty Court Add another Criminal Offense? Add another Criminal Offense? YesNo Describe the Offense: What was the Case Number? What was the Court Number? Which County and State charged you? What was the Court you were convicted? What was the Court you were convicted? District CourtCounty Court Add another Criminal Offense? Add another Criminal Offense? YesNo Describe the Offense: What was the Court Number? What was the Case Number? Which County and State charged you? What was the Court you were convicted? What was the Court you were convicted? District CourtCounty Court Add another Criminal Offense? Add another Criminal Offense? YesNo What was the Offense? What was the Case Number? What was the Court Number? Which County and State charged you? What was the Court you were convicted? What was the Court you were convicted? District CourtCounty Court Add another Criminal Offense? Add another Criminal Offense? YesNo What was the Offense? What was the Case Number? Which County and State charged you? What was the Court Number? What was the Court you were convicted? What was the Court you were convicted? District CourtCounty Court Driver's License Have you had a Driver's License during the last 10 years? Have you had a Driver's License during the last 10 years? YesNo Court Which COUNTY is this being filed? SelectAndersonAndrewsAngelinaAransasArcherArmstrongAtascosaAustinBaileyBanderaBastropBaylorBeeBellBexarBlancoBordenBosqueBowieBrazoriaBrazosBrewsterBriscoeBrooksBrownBurlesonBurnetCaldwellCalhounCallahanCameronCampCarsonCassCastroChambersCherokeeChildressClayCochranCokeColemanCollinCollinsworthColoradoComalComancheConchoCookeCoryellCottleCraneCrockettCrosbyCulbersonDallamDallasDawsonDeaf SmithDeltaDentonDeWittDickensDimmittDonletDuvalEastlandEctorEdwardsEllisEl PasoErathFallsFanninFayetteFisherFloydFoardFort BendFranklinFreestoneFrioGainesGalvestonGarzaGillespieGlasscockGoliadGonzalesGrayGraysonGreggGrimesGuadalupeHaleHallHamiltonHansfordHardemanHardinHarrisHarrisonHartleyHaskellHaysHempillHendersonHidalgoHillHockleyHoodHopkinsHoustonHowardHudspethHuntHutchinsonIrionJackJacksonJasperJeff DavisJeffersonJim HoggJim WellsJohnsonJonesKarnesKaufmanKendallKenedyKentKerrKimbleKingKinneyKlebergKnoxLamarLambLampasasLa SalleLavacaLeeLeonLibertyLimestoneLipscombLive OakLlanoLovingLubbockLynnMcCullochMcLennanMcMullenMadisonMarionMartinMasonMatagordaMaverickMedinaMenardMidlandMilamMillsMitchellMontagueMontgomeryMooreMorrisMotleyNacogdochesNavarroNewtonNolanNuecesOchiltreeOldhamOrangePalo PintoPanolaParkerParmerPecosPolkPotterPresidioRainsRandallReaganRealRed RiverReevesRefugioRobertsRobertsonRockwallRunnelsRuskSabineSan AugustineSan JacintoSan PatricioSan SabaSchleicherScurryShackelfordShelbyShermanSmithSomervellStarrStephensSterlingStonewallSuttonSwisherTarrantTaylorTerrellTerryThrockmortonTitusTom GreenTravisTrinityTylerUpshurUptonUvaldeVal VerdeVan ZandtVictoriaWalkerWallerWardWashingtonWebbWhartonWheelerWichitaWilbargerWillacyWilliamsonWilsonWinklerWiseWoodYoakumYoungZapataZavalaCounty This should be the same county where you reside. 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