Instructions for Name Change - Adult
Packet contains: Petition – Notice by Publication – Notice by Mail – Order
Read Directions Completely – Please Type or Print Neatly
Caution: Use of forms without the assistance of a lawyer could harm your legal rights. You
may want to have a lawyer review your completed forms before you file them with the court.
These are basic forms and may not cover every situation.
1. Petitioner: Complete the Civil Information Form, which can be found at
http://www.kscourts.org/pdf/civilcoversheet.pdf. You will only need to complete the Plaintiff
information section because there is not a defendant in a name change case. When
selecting the nature of the suit mark the Other Civil box located in the civil section.
2. Complete the Petition except for the case and court numbers.
3. Sign the Petition in front of a Notary.
4. File the original and 1 copy with the Clerk of the District Court. The filing fee is $156 with
$10 surcharge for a total of $166.
5. Obtain case number and Court Division assignment from the Clerk of the District Court
when you file.
6. Contact the Administrative Assistant for the court to which the case has been assigned,
obtain a date and time for a hearing before the court and ask what that judge requires for
notice (publication, mail or both).
7. Give notice as required by the judge.
Notice by publication requires you to publish notice of the hearing once a week for three
weeks in one of the local papers that publishes legal notices. The paper may send a
statement of publication directly to the court or to you. If it is sent to you be sure to bring
it with you to the hearing for filing with the Clerk of the District Court.
Each notice by mail should be sent by registered mail – return receipt requested. Bring the
return receipt(s) with you to the hearing for filing with the Clerk of the District Court.
8. Complete the Order Changing Name for the judge’s signature. Bring it along with proof of
notice (see # 6) to the hearing.
9. Make several copies of the signed Order (Social Security, credit card companies etc. will
need a file stamped copy of the Order). File the Order with the Clerk of the District Court.
The additional copies will be file stamped for no additional charge at that time.
IN THE DISTRICT COURT, _________________ COUNTY, KANSAS
CIVIL COURT DEPARTMENT
In the Matter of the Petition of: )
)
[Name] ) Case No. ________________
)
To Change His/Her Name. ) Div. No. ________________
___________________________ )
Pursuant to Chapter 60
PETITION FOR CHANGE OF NAME
Petitioner states:
1. Petitioner has been a resident of Kansas for more than sixty (60) days before filing this
petition.
2. Petitioner’s birth certificate shows his/her name as
_______________________________________________.
3. Petitioner desires to have his/her legal name changed to _______________________.
4. The Petitioner desires the name change because______________________________
_______________________________________________________________________.
5. This Petition is not made for the purpose of avoiding any debts, obligations or legal process
nor will it result in prejudice to any person.
6. Petitioner’s best interests are served by the requested change in name.
WHEREFORE, Petitioner prays this Court set this matter for hearing, order services by
Publication, certified mail, or, if appropriate, waive any requirements for service; issue an order
changing Petitioner’s name from____________________ _________________________ to
_________________________ __________________and for such other further relief as the Court
deems appropriate under the circumstances.
_____________________________________
Petitioner, Pro Se
[Address]
[City, State, Zip]
[Telephone]
VERIFICATION
STATE OF KANSAS )
) ss:
COUNTY OF _____________)
_____________________________[Petitioner’s Name], of lawful age, being first duly sworn,
on his/her oath, states:
He/She is the Petitioner in the above-captioned matter; that he/she has read the above and
foregoing Petition and the statements, allegations, and matters contained herein are true and
correct.
_______________________________
Petitioner, Pro Se
SUBSCRIBED AND SWORN to before me on this ____ day of ___________, 2_____.
_______________________________
Notary Public
My Appointment Expires:
_____________________
(First Published in _________________________[Name of News Publication],
_______________, 200___
In the Matter of the Petition of: )
)
[Name] ) Case No. ________________
)
To Change His/Her Name. ) Div. No. ________________
___________________________ )
Pursuant to Chapter 60
NOTICE OF SUIT [PUBLICATION]
THE STATE OF KANSAS TO ALL WHO ARE OR MAY BE CONCERNED:
You are hereby notified that the above-named __________________________ [Petitioner’s
Full Name], filed his/her Petition in the above court on ________________, 200 _______,
praying for judgment and decree changing his/her name from _________________
____________________ [Petitioner’s Full Name] to _____________________________
[Petitioner’s New Full Name], and that said Petition will be heard (or assigned) by the Court in
Division ____, ________ County Courthouse, ________________, __________, Kansas, on the
_____day of ____________, 200_____, at ________ ____ . m. You are required to plead in
response to the petition on or before _________________, 200 _____ [Date at least 41 days after
first publication], in this Court.
If you fail to plead, judgment and decree will be entered in due course upon the Petition.
_____________________________
Petitioner, Pro Se
[Address]
[City, State, Zip]
[Telephone]
IN THE DISTRICT COURT, ________________COUNTY, KANSAS
CIVIL COURT DEPARTMENT
In the Matter of the Petition of: )
)
[Name] ) Case No. ________________
)
To Change His/Her Name. ) Div. No. ________________
___________________________ )
Pursuant to Chapter 60
NOTICE OF SUIT [MAIL]
[DATE]
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
[Company, Business or Firm]
[Address]
[City, State, Zip]
Re: [Petitioner’s Full Name]
[Account No.]
Dear:_________________
Please take notice that the above-referenced individual filed a Petition in __________
County
District Court, _________ County, Kansas, on ___________________, 200___, to change
his/her legal name from ______________________ [Petitioner’s Full Name] to
___________________________________ [Petitioner’s Requested Name].
Petitioner’s Petition will be heard in _____________ County District Court, ___________
County Courthouse, _______________, ______________, Kansas, on the ________day of
______________, 200_______, at ______ __.M.
If you have any objection to the requested name change, you are required to file a
responsive pleading or appear at the hearing and object to the requested name change. If you fail
to act, judgment and decree will be entered in due course upon Petitioner’s Petition.
Very truly yours,
_____________________
Petitioner, Pro Se
[Address]
[City, State, Zip]
[Telephone]
IN THE DISTRICT COURT, ________________COUNTY, KANSAS
CIVIL COURT DEPARTMENT
In the Matter of the Petition of: )
)
[Name] ) Case No. ________________
)
To Change His/Her Name. ) Div. No. ________________
___________________________ )
Pursuant to Chapter 60
ORDER CHANGING NAME
NOW, on this _____ day of _______________, 20_____ , the above-captioned matter
comes before the Court upon the Petition of ___________________________ [Petitioner’s Full
Name], for change of his/her name. Petitioner appears in person. There are no other appearances.
The Court, after review of the record of the proceedings herein, approves service or waives
any requirement for notice and determines the matter may proceed to hearing.
The Court, upon hearing the testimony, upon examining the evidence presented, and upon
review of the record of the proceedings herein, finds as follows:
1. The Court has jurisdiction over the parties and the subject matter in this case.
2. Venue is appropriate in Johnson County, Kansas.
3. Service has been properly obtained on, or notice has been given to, all interested parties,
or service and notice have been waived because there are no interested parties other than
petitioner.
4. The allegations contained in Petitioner’s Petition are true.
5. Petitioner, __________________________________ [Full Name], is now and has been a
bona fide resident of Kansas, for a period of more than sixty (60) days immediately
preceding the filing of the Petition.
6. Petitioner’s birth certificate shows his/her name as ____________________________
[Petitioner’s Name].
7. Petitioner seeks to change his/her legal name shown on his/her birth certificate to
_______________________________________ [Petitioner’s Requested Name]
because ___________________________________________________
____________________________________________________________
______________________________________________________ .
8. The Petition for Order Changing Name is not made for the purpose of avoiding any
debts, obligations or legal process nor is it made for the purpose of misleading or defrauding
any person. The requested name change will not result in prejudice to any person.
9. No objections have been made to the Court and the Court finds Petitioner is entitled
to have his/her legal name shown on his/her birth certificate changed to
__________________________________ [Petitioner’s Requested Name].
IT IS THEREFORE BY THE COURT CONSIDERED, ORDERED, ADJUDGED, AND
DECREED that the above and foregoing findings are made as orders of this Court, that the name
shown on Petitioner’s birth certificate of _______________________________ [Petitioner’s Full
Name is hereby ordered changed to _________________________________________
[Petitioner’s Requested Name], and that the costs of this proceeding are assessed against
Petitioner.
IT IS SO ORDERED.
______________________________
Judge of the District Court
SUBMITTED BY:
____________________________
Petitioner, Pro Se
[Address]
[City, State, Zip]
[Telephone]
