INSTRUCTIONS: APPLICATION FOR CHANGE OF NAME (Adult) CC-1411

This application cannot be used for the name change of a minor. A probationer or incarcerated person may submit an application if the court finds good cause for the name change.

“Application for Change of Name (Adult) CC-1411 Step 1”

Check the appropriate box on the first line and fill in your city or county. Fill in your current full name in the second line. Fill in your full name on the third line as well.

“Application for Change of Name (Adult) CC-1411 Step 2”

In part 1, provide your full birth name. Fill in your current residential address in part 2. If your mailing address is different from your residential address, fill in part 3.

“Application for Change of Name (Adult) CC-1411 Step 3”

Provide your full date of birth in part 4a. Provide your place of birth in part 4b including city and state.

“Application for Change of Name (Adult) CC-1411 Step 4”

Provide the full names of your father and mother in parts 5 and 6.

“Application for Change of Name (Adult) CC-1411 Step 5”

Check the appropriate box in part 7 indicating whether or not you’ve ever been convicted of a felony. If you check “Yes” in part 8, include the name of your facility name and location. If you check “Yes” in part 9, provide the court name. If you check “Yes” in part 10, attach a court order or similar documentation highlighting the change of name.

“Application for Change of Name (Adult) CC-1411 Step 6”

On the second page, provide your full current name and your requested change of name.

“Application for Change of Name (Adult) CC-1411 Step 7”

Sign the document on the “Applicant” line in front of Notary Public. The Clerk, Deputy Clerk or Notary Public will fill in the bottom of the document.

“Application for Change of Name (Adult) CC-1411 Step 8”

Before bringing this form to the County Court, you need to make copies of the original as determined by your specific district. You are encouraged to hire an attorney to help you with this form and any other required forms.