Instructions For Changing the Name of a Minor...Affidavit of Service must be filed prior to the Final Hearing. When filing the Application When filing the Application for Name Change,

Instructions For Changing the Name of a Minor

1. Only a District of Columbia resident may request a change of name regardless of where they were born.

2. The application for Change of Name of a Minor must be filed in Judge-in-Chambers, District of Columbia Superior Court, 500 Indiana Avenue, NW, Room 4220, Washington, DC 20001.

3. The application will be reviewed for completion, clarity and proper supporting documentation.

4. The minor child must be a current resident of the District of Columbia and must be able to provide proof of residency (e.g., utility bill {water, gas , electric, oil or cable} or telephone bill {no cell phone, wireless or pager bills acceptable} issued within the last 60 days, a real property tax bill, pay stub, W-2 statement, letter with picture from Court Services and Offender Supervision Agency “CSOSA” or DC Department of Corrections certifying the applicant’s name and residence).

5. On behalf of the minor child the applicant must have an original or certified copy of their birth certificate. The clerk will make a copy for the court records and return the original or certified copy to the applicant.

6. Foreign birth certificates must be translated into English by a professional translator who swears to the accuracy of the translations and who provides the applicant’s name, address, telephone, number and email address if any.

7. On behalf of the minor child the applicant must present valid photo identification. The clerk will make a copy for the court record and return the original to the applicant.

8. The cost of filing an application for Change of Name of a Minor is $60.00 (cash, money order, or credit card).

To File for Name Change

9. In a addition to the birth certificate, the following supporting documentation, if applicable, is required:• Marriage Certificate• Divorce Decree• Proof of U.S.A. Citizenship/ Certificate of Citizenship• Child Support Order(s)• Acknowledgment of Paternity (The application must provide all acknowledgment(s) of

paternity that the applicant has signed.)• Adjudication of Paternity (The applicant must provide all Adjudication(s) of Paternity).• Order Terminating Parental Rights (The applicant must provide all Order(s) Terminating

Applicant’s Parental Rights.)• Other documentation that the court may require

10. The minor child requesting a change of name as a result of becoming a citizen of the United States of America must present proof of citizenship.

11. On behalf of the minor child it is the applicant’s responsibility to submit all of the applicable supporting documents for the court’s consideration.

12. On behalf of the minor child the applicant must provide the reason(s) for the request to change their name.

13. On behalf of the minor child the applicant will be provided with a Final Hearing date on which to return to complete the process for change of name.

Continued

Service of Process

14. Within ten (10) days of filing the Application for Change of Name of a Minor, the applicant must mail or personally serve all interested parties, with a copy of the Application for Name Change and the Notice of Final Hearing. Failure of the applicant to comply with this ten (10) day requirement will result in a dismissal of the Application without prejudice.

15. By the date of the Final Hearing, the applicant must file the Affidavit(s) of Service by Mailing and/or the Affidavit(s) of Personal Service for each interested person.

17. On behalf of the minor child the applicant will be required to notify their creditors via certified or registered mail and provide a certified letter receipt.

16. If the minor child is not a United States citizen, they must notify Homeland Security-US Immigration and Customs, Washington Field Office - 7, MS 2480, US Citizenship and Immigration Services, 2675 Prosperity Avenue, Fairfax, Virginia 20598-2480 personally or by certified or registered mail. An Affidavit of Service must be filed prior to the Final Hearing.

Examples of creditors include:• Mortgage Companies • Landlords• Student Loan Companies• Finance Companies• Loan Companies• Credit Card Companies (Even if there is a zero balance)• Utility Companies

18. Even if the minor child credit card company has issued a credit card in the applicant’s requested name, on behalf of the minor the applicant is still required to notify this creditor of the requested name change by certified or registered mail, with a return receipt and must file an Affidavit of Service prior to the Final Hearing.

Continued

19. If the minor child has a juvenile record, the applicant must notify the Court Social Services, the Department of Youth Rehabilitation Services and the Chief of the Metropolitan Police Department either personally or by certified or registered mail. An Affidavit of Service must be filed prior to the Final Hearing.

20. If the minor child has a criminal record in a jurisdiction other than the District of Columbia, applicant must send notice to the appropriate law enforcement official in the state and county where the conviction was entered including police chief or sheriff and department of corrections either personally or by certified or registered mail. An Affidavit of Service must be filed before the Final Hearing.

21. If the minor child has a current criminal case, they must send notice to their probation, parole or supervision officer personally or by registered or certified mail. An Affidavit of Service must be filed prior to the Final Hearing.

22. If the minor child is incarcerated in a jurisdiction other than the District of Columbia, notice shall be sent to the Federal Bureau of Prisons personally or by registered or certified mail. An Affidavit of Service must be filed prior to the Final Hearing.

23. If the minor child either has a current bankruptcy case, or has previously filed for bankruptcy, they must notify the Bankruptcy Court personally or by certified or registered mail. An Affidavit of Service must be filed prior to the Final Hearing. When filing the Application for Name Change, the applicant must file a copy of the Discharge Order, if one exists.

24. If the applicant on behalf of the minor child fails to notify an interested party, the Application for Name Change will not be processed and the Application may be dismissed without prejudice.

Final Hearing & Applicant Requirements

25. If any person desires to oppose the Application of Name Change of a Minor, that person, or their attorney must be present at the Final Hearing or must file a written detailed objection in Judge-In-Chambers at least five (5) business days in advance of the Final Hearing. If a written objection is filed, it also must be mailed to the applicant or applicant’s counsel.

26. The approval of the Application for Change of Name of a Minor requires a Final Hearing that will be held either before a judge in Family Court or Judge-In-Chambers.

27. The process may take approximately 2 –to– 5 weeks to complete.

28. If an Application of a Name Change of a Minor is granted, the applicant will be provided with two certified copies of the Order for Name Change. It is the applicant’s responsibility to provide a copy of the court’s Order to officials in the State/jurisdiction in which they were born.

REVISED –CON-June 19, 2014

Family Court

Print Minor’s Current Name Being Used:Case Number:

I, applicant(s),respectfully represents to the Court:

Location: 500 Indiana Avenue, NW Room 4220 4th Floor Washington, DC 20001

Superior Court of The District of Columbia

Application for Change of Name of a MinorPLEASE PRINTBirth Certificate Number:

Pursuant to Civil Rule 205 and DC Code §§ 16-2501, and 2503

Minor’s Full Name:(As it appears on the Birth Certificate)

Date of Birth:

Place of Birth:

First Middle Last

Month Day Year

City State

Sex

Yes NoWere parents married at time of birth?

Male Female

Full Name of Applicant

Full Name of Applicant

Telephone Number

Telephone Number

FatherMother Guardian Authorized agent, attorney or legal representative of the person listed (Proof Required)

Applicant 1:

Applicant 2:

Other/ Next Friend:

Address

Address

Relationship to the name on the Birth Certificate:

1. The minor presently resides at Address

Address

8. Has the minor’s name previously been changed? YES NO (If yes, give name changed, dates, places and reasons)

9. Has the minor ever been known by or used any other name than present name you desire to assume? YES NO (If yes, give all such name(s), dates, places and reasons)

I Further Declare as Follows

6. Father’s full name:

7. Other Parent’s full name:(As it appears on Birth Certificate)

(As it appears on Birth Certificate)

4. Minor’s Social Security Number:

5. Mother’s full name:(As it appears on Birth Certificate)

2. The applicant is seeking a Change of Name of a Minor from:

3. Has there been a Voluntary Acknowledgment of Paternity form completed and signed by both parents under oath? YES NO (If yes, please select the appropriate box)

to:for the following reason(s):

Division of Vital Records, Department of Health Office of Attorney GeneralHospitalOther

Any State Court Jurisdiction

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10. Is there any existing Child Support Order relating to the minor child in any State under any parent’s name? YES NO

Case Number(s):State(s):

11. Is the minor a party in any court case(s) that is/are currently open/pending YES NO (If yes, give case number(s), case caption, state(s), name of Court(s) and circumstances)

14. Has the minor ever been the subject of a Bankruptcy, Receivership or Insolvency Proceeding? YES NO (If yes, give circumstances, and case number(s))

12. Are you aware of any court case, decedent’s estate, probate matter, guardianship, conservatorship, trust, heirship, fiduciary power, patent, trademark, copyright, goodwill, privacy, partnership, corporation or other person, entity or proceeding that may be affected by the proposed change of name? YES NO (If yes, give case number(s), names of person(s) or business(es) involved, states, name of courts and circumstances)

13. Are you aware of any open or closed public agency proceeding(s) that may be affected by the proposed change of name? YES NO (If yes, give case, RFP, permit, license and/or application number(s), case caption, state(s), name of court(s) and circumstances)

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15. Is the minor on probation or supervised release in any jurisdiction? YES NO (If yes, give specifics including the supervising agency, name, telephone number and address for the person to whom the minor child reports):

16. Delinquency/Juvenile History: (Choose one only)

Event (arrest, charge, plea, or adjudication) City/State Date

The minor child has never been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication.

The minor child has a juvenile history. In the past, the minor child was arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. The details of the criminal history are:

17. Is the minor currently registered or required to register as a sex offender in any jurisdiction? YES NO (If yes, give specifics including the state(s), name(s) and address(es) for the agency(ies) maintaining the registry(ies)):

20. List names and address(es) of any creditor(s) (including mortgage, loan(s) and credit card companies, even if there is a zero balance):

19. Has a Judgment or Decree ever been entered against the minor in any jurisdiction? YES NO (If yes, has the Judgment or Decree been paid or satisfied?) YES NO (If no, give the type of case, date, state and any other pertinent information):

18. Is the minor currently registered or required to register as a gun offender in any jurisdiction? YES NO (If yes, give specifics including the state(s), name(s) and address(es) for the agency(ies) maintaining the registry(ies)):

Continued

THE APPLICANT HEREBY CERTIFIES THAT (1) THIS APPLICATION HAS NOT BEEN FILED FOR ANY FRAUDULENT OR UNDISCLOSED PURPOSE, STATUS, PAST OR PRESENT AND (2) THE GRANTING OF THE APPLICATION WILL NOT INFRINGE UPON THE RIGHTS OF OTHERS RELATING TO ANY PARTNERSHIP, CORPORATION, PATENT, TRADEMARK, COPYRIGHT, GOODWILL, PRIVACY OR OTHERWISE.

Sworn to and subscribed before me on this Day of

OR

I declare under penalty of perjury under the law of the District of Columbia that the foregoing is true and correct.

Executed on this the Day of , 20 .

Applicant Signature 1

Applicant Signature 2

Signature of Notary Public

Commission Expires

Deputy Clerk Signature




Case Number Date of BirthBirth Certificate Number

I, , say upon oath that I am the:

of the above-captioned and that the allegations contained in said Application are true to the best of my knowledge, and that this Application to Amend Birth Certificate is presented in good faith, and that I have no opposition to this Application and hereby consent to the request to amend the minor’s and/or adult‘s birth certificate.

Minor’s Full Name(As it appears on the Birth Certificate) First Middle Last

Print Full Name

Consent to the Request For Change of Name

Family Court

Other: Guardian/ Next Friend AttorneyFather Mother

Address:

Telephone Number: Notary Public/Deputy Clerk Commission Expires:

Applicant’s Signature


I,

having filed an application for judgment changing the name from

to ; it is by the Court this day

of 20 , hereby

ORDERED, that the Final Hearing on this application to change name of a minor will be held in Family Court, Court Room before Judge in the District of Columbia at 500 Indiana Avenue N.W., Washington, DC 20001, on the day of , 20 at : a.m./p.m. If any person desires to oppose this application, that person or his or her attorney must be present at the hearing or file written detailed objections five (5) business days in advance of the hearing with Family Court and mail a copy to the applicant or applicant’s counsel; and it is further

the applicant must send the application for change of name of a minor and notice of final hearing to the applicant’s creditors personally or by registered or certified mail and show proof of service by filing the affidavit/declaration of service.

the applicant must send the application for change of name of a minor and notice of final hearing to the D.C. Chief of Police, 300 Indiana Avenue, N.W., Room 5080, Washington, D.C. 20001, the Department of Youth Rehabilitation Services and the Court Social Services personally or by registered or certified mail and show proof of service by filing the affidavit/declaration of service.

the applicant must send the application for change of name of a minor and notice of final hearing to the current probation, parole or supervisory release officer personally or by registered or certified mail and show proof of service by filing the affidavit/declaration of service.

the applicant must send the application for change of name of a minor and notice of final hearing to the appropriate law enforcement official in (Jurisdiction) state and county where conviction was entered including police chief or sheriff and department of corrections personally or by registered or certified mail and show proof of service by filing the affidavit/declaration of service.

Family Court



Order and Notice of Final HearingPLEASE PRINT

Case Number

Minor’s Full Name First Middle Last

Minor’s Full Name

Minor’s Full Name

Applicant’s Full Name


ORDERED, on behalf of minor that: (Check all that applies)

Continued

the applicant must send the application for change of name of a minor and notice of final hearing to the Bankruptcy Court personally or by registered or certified mail and show proof of service by filing the affidavit/declaration of service.

the applicant must send the application for change of name of a minor and notice of final hearing to the Homeland Security-US Immigration and Customs, Washington Field Office - 7, MS 2480, US Citizenship and Immigration Services, 2675 Prosperity Avenue, Fairfax, Virginia 20598-2480 personally or by certified or registered mail and show proof of service by filing the affidavit/declaration of

If incarcerated in a jurisdiction other that the District of Columbia, the applicant must send the application for change of name of a minor and notice of final hearing to the personally or by registered or certified mail and show proof of service of mailing by filing the affidavit/

SO ORDERED.

Judge’s Signature

Print Judge’s Name REVISED –CON-June 19, 2014

Upon consideration of the Application for Change of Name filed herein and no objections having been made and filed herein, and all other requirements appear having been met; it is by the Court this day of 20 , hereby

ORDERED, that the said Application for Change of Name be and hereby is

Judge’s Signature

Family Court



Order For Change of NamePLEASE PRINT

Case Number




Shall be known as

ORDERED, that

DENIED; and it is furtherGRANTED

Print Judge’s Name

First Middle Last

First Middle Last

Name(s) of Person(s) Served Address Date Mailed

I declare under penalty of perjury under the law of the District of Columbia that the foregoing is true and correct. Executed on this the day of , 20 .

Subscribed and sworn to before me this day of , 20 .

I applicant applicant’s counsel, being duly sworn, state that my address is I further swear that I served the Notice(s) of Final Hearing and the Application to Change Name on the person or persons named below by placing in an official depository of the United States Postal Service a copy of the Notice of Final Hearing and the Application to Change Name in an envelope, postage prepaid by certified or registered mail. I further swear that I have attached the receipts of mailing to the person(s) listed below and that all mailing(s) were made within 10 days of the filing of the Application to Change Name.

Family Court



PLEASE PRINT Affidavit/ Declaration of Service by Mail(For Change of Name of a Minor)

Case Number


Telephone Number:

Telephone Number:

Applicant’s Signature

Applicant Counsel’s Signature OR

ORAffiant’s Signature

Notary Public REVISED –CON-June 19, 2014

I, , age 18 or older, residing or workingat , am not a party and have no interest in this case.

On , 20 , at AM/PM. I served a copy of the Application of Change of Name and Notice of Final Hearing as follows personally on at

Below, you must set forth specific facts from which the Court can determine that process was served as indicated above, including a physical description (approximate age, height, weight) of any person on whom service was made:

Family Court



PLEASE PRINT Affidavit/ Declaration of Personal Service(For Change of Name of a Minor)

Case Number


Affiant’s Signature

I declare under penalty of perjury under the law of the District of Columbia that the foregoing is true and correct. Executed on this the day of , 20 .

Process Server

Affiant’s Signature

Notary Signature Subscribed and sworn to before me this day of , 20 .

OR


Name 18: Name 14: Name 15: Name 16: Check Box 43: OffCheck Box 44: OffCheck Box 45: OffName 5: Name 7: Name 9: Name 8: Name 45: Check Box 46: OffCheck Box 47: OffCheck Box 48: OffCheck Box 49: OffCheck Box 53: OffCheck Box 54: OffName 19: Name 23: Name 112: Name 41: Name 113: Name 82: Name 125: Name 20: Name 21: Family Division 5: OffFamily Division 7: OffFamily Division 6: OffFamily Division 8: OffName 31: Name 32: Name 33: Name 34: Name 35: Name 36: Name 28: Name 30: Name 24: Name 25: Name 26: Name 27: Name 114: Family Division 31: OffFamily Division 32: OffFamily Division 33: OffFamily Division 35: OffFamily Division 34: OffFamily Division 37: OffFamily Division 36: OffFamily Division 9: OffFamily Division 10: OffName 37: Name 38: Family Division 11: OffFamily Division 12: OffName 39: Name 40: Name 42: Family Division 17: OffFamily Division 18: OffName 51: Name 52: Family Division 13: OffFamily Division 16: OffFamily Division 14: OffFamily Division 15: OffName 43: Name 44: Name 47: Name 48: Name 49: Family Division 21: OffFamily Division 22: OffName 57: Name 58: Name 115: Name 118: Name 121: Name 116: Name 119: Name 122: Name 117: Name 120: Name 123: Family Division 25: OffFamily Division 39: OffFamily Division 23: OffFamily Division 24: OffName 60: Name 61: Name 69: Name 70: Name 71: Name 72: Family Division 27: OffFamily Division 28: OffFamily Division 29: OffFamily Division 30: OffName 66: Name 67: Family Division 26: OffFamily Division 38: OffName 63: Name 64: Name 65: Name 75: Name 76: Name 77: Name 80: Name 81: Check Box 58: OffCheck Box 59: OffCheck Box 60: OffCheck Box 61: OffCheck Box 63: OffName 89: Name 94: Name 104: Name 126: Name 127: Name 128: Name 129: Name 130: Name 131: Check Box 36: OffCheck Box 64: OffCheck Box 38: OffCheck Box 39: OffName 83: Name 84: Name 85: Name 86: Name 87: Name 95: Name 96: Name 88: Name 90: Name 92: Name 134: Name 93: Name 111: Name 91: Name 132: Name 98: Check Box 40: OffCheck Box 41: OffCheck Box 42: OffName 133: Check Box 55: OffCheck Box 56: OffName 55: Name 100: Name 101: Name 102: Name 103: Name 6: Name 10: Check Box 19: OffCheck Box 20: OffCheck Box 21: OffCheck Box 22: OffName 1024: Name 1025: Name 1026: Name 1027: Name 1028: Name 1029: Name 1030: Name 1031: Name 1032: Name 1033: Name 1034: Name 1035: Name 1036: Name 1037: Name 1038: Name 1039: Name 1040: Name 1041: Name 1042: Name 1043: Name 1044: Name 1045: Name 1046: Name 1047: Name 1048: Name 1049: Name 1050: Name 1051: Name 1052: Name 1053: Name 1054: Name 1055: Name 1056: Name 1057: Name 1058: Name 1059: Name 1060: Name 1061: Name 1062: Name 1063: Name 1064: Name 1065: Name 1068: Name 1069: Name 1070: Name 1066: Name 1067:

Documents

Instructions For Changing the Name of a Minor...Affidavit of Service must be filed prior to the Final Hearing. When filing the Application When filing the Application for Name Change,