Name Change Petition

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

Pennsylvania requires the use of official county Court of Common Pleas name change forms 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. Contact your county Prothonotary's office
or visit your county court website for official forms. Do not file this document directly with the court.

This petition is for an adult seeking a legal name change in Pennsylvania. The petition must be filed in the Court of Common Pleas of the county where the petitioner resides. Publication of notice is required in two newspapers of general circulation in the county. The petitioner must present proof of publication and an official search showing no judgments, liens, or decrees against the petitioner from the current county and any county of residence during the prior five years. A hearing is required between one and three months after filing. Review 54 Pa.C.S. Chapter 7 before filing.

TABLE OF CONTENTS

1. Caption
2. Petitioner Information
3. Residency History
4. Current Name and Proposed Name
5. Grounds for Name Change
6. Criminal History Disclosure
7. Publication Requirement
8. Official Search Requirement
9. Safety Exception
10. Prayer for Relief
11. Verification
12. Proposed Decree
13. Pennsylvania-Specific Notes

1. CAPTION

IN THE COURT OF COMMON PLEAS OF [________________________________] COUNTY, PENNSYLVANIA

CIVIL DIVISION

In Re: Change of Name of

[CURRENT FULL LEGAL NAME]

To

[PROPOSED NEW NAME]

No.: [________________________________]

PETITION FOR CHANGE OF NAME

(Pursuant to 54 Pa.C.S. § 701 et seq.)

2. PETITIONER INFORMATION

TO THE HONORABLE JUDGES OF THE SAID COURT:

The Petition of [CURRENT FULL LEGAL NAME] respectfully represents:

1. Petitioner's current full legal name: [________________________________]

2. Petitioner's requested new name: [________________________________]

3. Petitioner's date of birth: [__/__/____]

4. Petitioner's place of birth: [________________________________]

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

6. Petitioner's current residential address: [________________________________]

7. Petitioner's telephone number: [________________________________]

3. RESIDENCY HISTORY

8. Petitioner currently resides at: [________________________________], [________________________________] County, Pennsylvania.

9. Petitioner has resided at the current address since: [__/__/____]

10. All addresses of residence for the five (5) years prior to the date of this Petition:

4. CURRENT NAME AND PROPOSED NAME

11. Petitioner's current full legal name is: [________________________________]

12. Petitioner desires to change their name to: [________________________________]

13. The reason for the name change is: [________________________________]

14. Previous name changes:
    ☐ Petitioner has not previously changed their name by court order
    ☐ Petitioner previously changed their name: [________________________________]

5. GROUNDS FOR NAME CHANGE

15. The specific reason(s) for the requested name change:

☐ Marriage or domestic partnership
☐ Divorce or dissolution of marriage
☐ Personal preference
☐ Religious reasons
☐ Gender identity
☐ Desire to adopt family surname
☐ Correction of error in official records
☐ Other: [________________________________]

16. Detailed explanation of grounds: [________________________________]

6. CRIMINAL HISTORY DISCLOSURE

17. Petitioner discloses the following regarding criminal history:

☐ Petitioner has NO criminal convictions.
☐ Petitioner has the following criminal convictions:

18. Petitioner is currently:
    ☐ Not on probation, parole, or any court supervision
    ☐ On probation for: [________________________________]
    ☐ On parole for: [________________________________]

19. Petitioner:
    ☐ Is NOT required to register as a sex offender under 42 Pa.C.S. Chapter 97 (Megan's Law)
    ☐ IS required to register as a sex offender

7. PUBLICATION REQUIREMENT

20. Petitioner understands that pursuant to 54 Pa.C.S. § 703, notice of the filing of this Petition and the hearing date must be published in two (2) newspapers of general circulation in [________________________________] County (or a county contiguous thereto).

21. Petitioner will publish notice in the following newspapers:

Newspaper 1: [________________________________]
Newspaper 2: [________________________________]

22. ☐ Petitioner requests waiver of notice because notice would jeopardize the safety of the Petitioner or Petitioner's child or ward (see Section 9 below).

8. OFFICIAL SEARCH REQUIREMENT

23. Petitioner understands that at the hearing, Petitioner must present an official search from the Prothonotary and Clerk of Court of each county where Petitioner has resided within the five years prior to filing, showing:

☐ No judgments of record against Petitioner
☐ No decrees of record against Petitioner
☐ No other similar matters of record against Petitioner

24. Counties where official searches will be obtained:

9. SAFETY EXCEPTION

☐ This section does not apply.
☐ Petitioner requests waiver of the notice requirement and sealing of the file.

25. Petitioner states that publication of notice would jeopardize the safety of:
    ☐ Petitioner
    ☐ Petitioner's child or ward

26. Basis for safety concern: [________________________________]

10. PRAYER FOR RELIEF

WHEREFORE, Petitioner respectfully requests that this Honorable Court:

A. Accept the filing of this Petition for Change of Name;

B. Set a hearing date between one (1) and three (3) months from the date of filing;

C. Direct publication of notice as required by 54 Pa.C.S. § 703;

D. After hearing, proof of publication, and official searches, enter a Decree changing Petitioner's name from [CURRENT FULL LEGAL NAME] to [PROPOSED NEW NAME];

E. ☐ Waive the notice requirement and seal the file (if applicable);

F. Grant such other and further relief as the Court deems just and proper.

11. VERIFICATION

I, [CURRENT FULL LEGAL NAME], verify that the statements made in this Petition are true and correct to the best of my knowledge, information, and belief. I understand that the statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.

Petitioner Signature: [________________________________]

Printed Name: [________________________________]

Date: [__/__/____]

12. PROPOSED DECREE

IN THE COURT OF COMMON PLEAS OF [________________________________] COUNTY, PENNSYLVANIA

CIVIL DIVISION

In Re: Change of Name of

[CURRENT FULL LEGAL NAME]

No.: [________________________________]

DECREE

AND NOW, this [____] day of [____________], [____], upon consideration of the Petition for Change of Name, proof of publication, official searches of the records, and after hearing, the Court being satisfied that there is no lawful objection to the granting of the Petition:

IT IS HEREBY ORDERED AND DECREED that the name of [CURRENT FULL LEGAL NAME] is changed to [PROPOSED NEW NAME].

☐ IT IS FURTHER ORDERED that the file in this matter be sealed for the safety of the Petitioner.

BY THE COURT:

_________________________________________
Judge, Court of Common Pleas

13. PENNSYLVANIA-SPECIFIC NOTES

Filing Court: Court of Common Pleas of the county where the petitioner resides (54 Pa.C.S. § 701).

Filing Fee: Approximately $150-$350 (varies by county; contact the Prothonotary for current fees).

Hearing Timeline: The hearing must be held not less than one month and not more than three months after the petition is filed (54 Pa.C.S. § 704).

Two-Newspaper Publication: Notice must be published in two newspapers of general circulation in the county of residence or a contiguous county (54 Pa.C.S. § 703).

Official Searches Required: At the hearing, the petitioner must present official searches from the Prothonotary and Clerk of Court of the current county and every county of residence within the prior five years, showing no judgments, decrees, or similar matters (54 Pa.C.S. § 704).

Five-Year Residency History: The petition must list all addresses for the five years prior to filing (54 Pa.C.S. § 702).

Spouse May Join: If the petitioner is married, the spouse may join as a party petitioner (54 Pa.C.S. § 701).

Safety Exception: The court may waive notice and seal the file if notice would jeopardize the safety of the petitioner or their child/ward (54 Pa.C.S. § 703).

Standard: The court may grant the petition if satisfied there is "no lawful objection" (54 Pa.C.S. § 704).

Verification Under Penalty: Pennsylvania permits verification under penalty of 18 Pa.C.S. § 4904 (unsworn falsification) in lieu of notarization.

Post-Order Actions: Update Pennsylvania driver's license, Social Security card, passport, birth certificate (PA Division of Vital Records), and other identification documents.

Sources and References:

• 54 Pa.C.S. Chapter 7
• 54 Pa.C.S. § 701
• PA Courts - Name Change Information