Name Change Petition

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

Connecticut requires the use of official Probate Court form PC-901 (Petition for Change
of Name — Adult) for name change petitions. This template provides the substantive legal
content to help you prepare — but you must transfer your content to the official form before
filing. The official form is available at
ctprobate.gov. 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 and Registry Screening
7. Notice to Interested Parties
8. Declaration and Verification
9. Order Granting Name Change
10. State-Specific Notes

Caption

CONNECTICUT PROBATE COURT
DISTRICT OF [________________________________]

In the Matter of the Change of Name of:

[________________________________]
(Current Legal Name of Petitioner)

Case No.: [________________________________]

PETITION FOR CHANGE OF NAME (ADULT)

(Conn. Gen. Stat. § 45a-99)

TO THE HONORABLE COURT:

Petitioner, [________________________________], respectfully petitions this Court pursuant to Connecticut General Statutes § 45a-99 for a decree 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 the Probate District of [________________________________], Connecticut, 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/civil union
☐ Personal preference
☐ Gender identity
☐ Return to maiden or former name
☐ Religious or cultural reasons
☐ Other: [________________________________]

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

[________________________________]
[________________________________]
[________________________________]

14. The requested name change is based on reasonable grounds and is not sought for any improper purpose, including but not limited to defrauding creditors, avoiding legal obligations, or evading law enforcement.

Criminal History and Registry Screening

15. Petitioner acknowledges that the Court will screen the Petitioner against the following registries:

☐ Connecticut Sex Offender Registry
☐ Connecticut Deadly Weapons Offender Registry

16. Sex Offender Registry Status:

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

17. Deadly Weapons Offender Registry Status:

☐ Petitioner is NOT listed on the Connecticut Deadly Weapons Offender Registry.
☐ Petitioner IS listed on the registry. Details: [________________________________]

18. Pending Criminal Charges:

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

19. Prior Felony Convictions:

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

Notice to Interested Parties

20. 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 CONNECTICUT
COUNTY OF [________________________________]

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

Notary Public / Commissioner of the Superior Court Signature: ____________________________________
Printed Name: [________________________________]
My Commission Expires: [__/__/____]

Order Granting Name Change

CONNECTICUT PROBATE COURT
DISTRICT OF [________________________________]

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

Case No.: [________________________________]

DECREE GRANTING CHANGE OF NAME

This matter having come before the Court upon the Petition of [________________________________] for a change of name pursuant to Connecticut General Statutes § 45a-99, and the Court having reviewed the Petition, screened the Petitioner against the Sex Offender Registry and Deadly Weapons Offender Registry, and being fully advised;

THE COURT FINDS THAT:

1. The Petitioner resides within the Probate District of [________________________________].

2. The Petitioner has shown reasonable grounds for the change of name.

3. The name change is not sought for any improper purpose.

4. Registry screening has been completed.

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

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

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

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

____________________________________
Probate Judge
District of [________________________________]

State-Specific Notes

Connecticut Name Change Key Points

• Court: Probate Court of the district where the petitioner resides (CGS § 45a-99) OR Superior Court (CGS § 52-11); concurrent jurisdiction.
• Statutory Authority: CGS § 45a-99 (Probate Court); CGS § 52-11 (Superior Court).
• Official Form: PC-901 (Petition for Change of Name — Adult).
• Publication: NOT required for adult name changes in Connecticut.
• Registry Screening: All applicants are screened against the Sex Offender Registry and Deadly Weapons Offender Registry.
• Commissioner Standing: The Commissioner of Emergency Services and Public Protection has standing to challenge a name change by a person required to register on either registry.
• Residency Requirement: Must reside in the probate district of filing; no specific minimum duration.
• Filing Fee: $250 in Probate Court; fee waiver available for qualifying individuals.
• Hearing: May be scheduled at the court's discretion; not always required if no objections are filed.
• Minor Name Changes: Require consent of both parents or compliance with additional procedures; use Form PC-910A.
• Sealed Records: The court may seal records in appropriate cases involving safety concerns.
• Gender Identity: Connecticut does not require publication, making the process simpler for all petitioners including those changing their name to conform to gender identity.

Sources and References

• CGS § 45a-99
• Connecticut Probate Court — Name Change Forms
• Connecticut Judicial Branch — Name Change Law