Name Change Petition

IMPORTANT: THIS IS A PREPARATION GUIDE — NOT THE OFFICIAL COURT FORM

Arkansas requires a Petition for Name Change to be filed in Circuit Court using forms provided
by or accepted by the local Circuit Court Clerk. This template provides the substantive legal
content to help you prepare — but you must transfer your content to the official form before
filing. Contact your county Circuit Court Clerk or visit
arlawhelp.org for official forms and instructions.
Do not file this document directly with the court.

PETITION FOR CHANGE OF NAME

Table of Contents

1. Caption
2. Petitioner Information
3. Current and Proposed Name
4. Residency Verification
5. Grounds for Name Change
6. Criminal History Disclosure
7. Publication Requirement
8. Notice to Interested Parties
9. Declaration and Verification
10. Order Granting Name Change
11. State-Specific Notes

Caption

IN THE CIRCUIT COURT OF [________________________________] COUNTY, ARKANSAS

In the Matter of the Name Change of:

[________________________________]
(Current Legal Name of Petitioner)

Case No.: [________________________________]

VERIFIED PETITION FOR CHANGE OF NAME

COMES NOW the Petitioner, [________________________________], and respectfully petitions this Honorable Court pursuant to Arkansas Code § 9-2-101 for an Order changing Petitioner's legal name, and in support thereof states as follows:

Petitioner Information

1. Full Current Legal Name: [________________________________]

2. Proposed New Legal Name: [________________________________]

3. Date of Birth: [__/__/____]

4. Place of Birth (City, State/Country): [________________________________]

5. Social Security Number (last four digits): XXX-XX-[____]

6. Current Mailing Address:
   [________________________________]
   [________________________________]
   [________________________________]

7. Telephone Number: [________________________________]

8. Email Address: [________________________________]

9. Driver's License / State ID Number: [________________________________]

Residency Verification

10. Petitioner is a resident of [________________________________] County, Arkansas, and resides within the jurisdiction of this Court.

11. Petitioner's current physical address is:
    [________________________________]
    [________________________________]

Grounds for Name Change

12. Petitioner seeks to change their legal name for the following reason(s):

☐ Marriage or civil union
☐ Divorce or dissolution of marriage
☐ Personal preference
☐ Gender identity
☐ Return to maiden or former name
☐ Religious or cultural reasons
☐ Common usage — Petitioner has been known by the proposed name for [____] years
☐ Other: [________________________________]

13. Detailed explanation of reasons for the requested name change:

[________________________________]
[________________________________]
[________________________________]

14. The requested name change is sought for good reasons and is not intended to defraud creditors, avoid legal obligations, or for any improper or illegal purpose.

Criminal History Disclosure

15. Petitioner discloses the following regarding criminal history:

☐ Petitioner has NOT been convicted of any felony offense.
☐ Petitioner HAS been convicted of a felony offense. Details: [________________________________]

16. Sex Offender Registry Status:

☐ Petitioner is NOT required to register as a sex offender under Arkansas law or the law of any other jurisdiction.
☐ Petitioner IS required to register as a sex offender. Details: [________________________________]

17. Pending Criminal Charges:

☐ Petitioner does NOT have any pending criminal charges.
☐ Petitioner DOES have pending criminal charges. Details: [________________________________]

Publication Requirement

18. Petitioner understands that publication of notice may be required by the court or local rule.

Notice to Interested Parties

19. Petitioner states that the following persons may have an interest in this proceeding:

☐ There are no interested parties who need to be notified.

Declaration and Verification

I, [________________________________], the Petitioner herein, being duly sworn, depose and state that I have read the foregoing Petition and that the statements contained herein are true and correct to the best of my knowledge, information, and belief.

Petitioner's Signature: ____________________________________

Date: [__/__/____]

STATE OF ARKANSAS
COUNTY OF [________________________________]

Subscribed and sworn to before me this [____] day of [________________], [____].

Notary Public Signature: ____________________________________
Printed Name: [________________________________]
My Commission Expires: [__/__/____]

[NOTARY SEAL]

Order Granting Name Change

IN THE CIRCUIT COURT OF [________________________________] COUNTY, ARKANSAS

In the Matter of the Name Change of:
[________________________________]

Case No.: [________________________________]

ORDER GRANTING CHANGE OF NAME

This matter having come before the Court upon the verified Petition of [________________________________] for a change of name pursuant to Arkansas Code § 9-2-101, and the Court having reviewed the Petition, considered the evidence presented, and being fully advised;

THE COURT FINDS THAT:

1. The Petitioner is within the jurisdiction of this Court.

2. The Petitioner has shown good reasons for the change of name.

3. No objections have been filed, or all objections have been heard and overruled.

IT IS THEREFORE ORDERED that the name of the Petitioner is hereby changed from [________________________________] to [________________________________], effective as of the date of this Order.

IT IS FURTHER ORDERED that the Petitioner may use the new name in all legal and official documents, records, and transactions.

☐ IT IS FURTHER ORDERED that the court file in this matter shall be sealed, the Petitioner having demonstrated by clear and convincing evidence that the Petitioner would otherwise be endangered.

The following identifying information is reflected as deemed appropriate by the Court:
[________________________________]

ENTERED this [____] day of [________________], [____].

____________________________________
Circuit Judge
[________________________________] County, Arkansas

State-Specific Notes

Arkansas Name Change Key Points

• Court: Circuit Court of the county where the petitioner resides.
• Statutory Authority: Arkansas Code § 9-2-101 (as amended by Act 2023, No. 331, effective 8/1/2023).
• Petition Format: Must be a verified petition in writing (sworn under oath).
• Standard for Approval: "Good reasons shown."
• Residency Requirement: Petitioner must be within the jurisdiction of the court; no specific minimum duration.
• Publication: Not explicitly required by statute; check local Circuit Court rules.
• Filing Fee: Approximately $165; contact the Circuit Clerk for the current amount.
• Sealed Records: The court SHALL seal the file upon clear and convincing evidence that the petitioner would otherwise be endangered (e.g., domestic violence, stalking).
• Court Order Contents: Under the 2023 amendment, the court order must reflect the petitioner's identifying information as deemed appropriate by the court.
• Minor Name Changes: Require consent of both parents or a court order; additional procedures apply under Arkansas Code § 9-2-102.
• Sex Offender Considerations: While not explicitly addressed in § 9-2-101, courts have discretion to deny name changes that would frustrate sex offender registration requirements.

Sources and References

• Arkansas Code § 9-2-101 (2024)
• Arkansas Legal Aid — Name Change for Adults
• Arkansas Name Change Laws