Form 61-4

This form is intended for use in obtaining a change of name in a situation not involving a dissolution of marriage. See Tex. Fam. Code §§ 6.706, 45.105.

NOTICE: THIS DOCUMENT
CONTAINS SENSITIVE DATA

[Caption. See § 3 of the Introduction in volume 1 of this manual.]

Original Petition for Change of Name of Adult

1.Discovery in this case is intended to be conducted under [level 2/level 3] of rule 190 of the Texas Rules of Civil Procedure. [If level 3, see form 5-1.]

Preservation of Evidence: Respondent is put on notice to preserve and not destroy, con­ceal, or alter any evidence or potential evidence relevant to the issues in this case, including tangible documents or items in Respondent’s possession or subject to Respondent’s control and electronic documents, files, or other data generated by or stored on Respondent’s home computer, work computer, storage media, portable systems, electronic devices, online reposi­tories, or cell phone.

2.Petitioner objects to the assignment of this matter to an associate judge for a trial on the merits or presiding at a jury trial.

3.This suit is brought by [name of petitioner], Petitioner. [Petitioner resides at [address, including county], Texas./Petitioner is a participant in the address confidentiality program administered by the attorney general under subchapter B of chapter 58 of the Texas Code of Criminal Procedure.] Petitioner is an adult. In accordance with section 45.102 of the Texas Family Code, the following information is supplied about Petitioner:

Full true name:

Sex:

Race:

Date of birth:

Place of birth: [city], [county] County, [state]

Driver’s license number and state of issuance of any license issued within the past ten years:

Social Security number:

FBI or SID number, if known, or other reference number to a criminal-history record system:

4.No offense has been charged against Petitioner above the grade of class C misde­meanor.

4.The following offense[s] [has/have] been charged against Petitioner above the grade of class C misdemeanor: [specify]

Case number:

Court of offense:

5.Petitioner has not been the subject of a final felony conviction.

5.Petitioner has been the subject of a final felony conviction and has [received a cer­tificate of discharge by the Texas Department of Criminal Justice, and not less than two years have passed from the date of receipt of discharge/completed a period of [community supervi­sion/juvenile probation] ordered by a court, and not less than two years have passed from the date of completion of [community supervision/juvenile probation]/been pardoned]. Peti­tioner’s change of name is in the interest or to the benefit of Petitioner and is in the interest of the public.

5.Petitioner is requesting a change of name to the primary name used in Petitioner’s criminal history record information.

6.Petitioner is not subject to the registration requirements of chapter 62 of the Texas Code of Criminal Procedure.

6.Petitioner is subject to the registration requirements of chapter 62 of the Texas Code of Criminal Procedure. Petitioner’s change of name is in the interest or to the benefit of Petitioner and is in the interest of the public, and proof that Petitioner has notified the appro­priate local law enforcement authority of the proposed name change [is attached/will be pro­vided].

6.Petitioner is subject to the registration requirements of chapter 62 of the Texas Code of Criminal Procedure. Petitioner is requesting a change of name to the primary name used in Petitioner’s criminal history record information, and proof that Petitioner has notified the appropriate local law enforcement authority of the proposed name change [is attached/will be provided].

7.Petitioner requests the Court to grant a change of Petitioner’s name to [first, mid­dle, and last names as they should appear in the order]. [Include if applicable: Petitioner asks the Court to order the Texas Department of State Health Services’ Vital Statistics Section to amend Petitioner’s birth certificate to reflect this change of Petitioner’s name.]

8.The reason for the requested change is [state specific reason for name change].

8.Petitioner includes a copy of an authorization card certifying in accordance with article 58.059 of the Texas Code of Criminal Procedure that Petitioner is a participant in the address confidentiality program administered by the attorney general under subchapter B of chapter 58 of the Texas Code of Criminal Procedure.

9.Petitioner includes with this Petition a legible and complete set of [his/her] finger­prints on a fingerprint card format acceptable to the Texas Department of Public Safety and the Federal Bureau of Investigation.

Petitioner prays that the Court grant Petitioner’s Petition for Change of Name of Adult.

Petitioner prays for general relief.

   
[Name]
Attorney for Petitioner
State Bar No.:
[Email address]
[Address]
[Telephone]
[Fax]

Verification

I, [name of petitioner], Petitioner, swear under oath that the facts stated in the above Original Petition for Change of Name of Adult are true and correct.

   
[Name of petitioner]

SIGNED under oath before me on ______________________________.

   
Notary Public, State of Texas