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This is not a substitute for legal advice. An attorney must be consulted.

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IN THE DISTRICT COURT FOR _______________ STATE, IN AND FOR _______________ COUNTY

In Re: _______________________

(Name of Petitioner)

_______________________

(Address of Petitioner)

CASE NO. ___________________

DECREE

AND NOW TO WIT, on this ________ day of ____________________, 20_____, the above-captioned Petition For Name Change having come before the Court for hearing; the Court having reviewed said Petition and the Court being fully advised in the premises, finds that the necessary and appropriate information has been presented to the Court including the required Certificate of Live Birth of the Petitioner necessary for a Name Change under the laws of the State of ________________________.

THE COURT FINDS the following to have been confirmed:

a) Petitioner’s New Name: ________________________________;

b) Petitioner’s Former Name: ________________________________;

c) Petitioner’s Social Security Number: __________/__________/___________;

d) Petitioner’s Address: ________________, _______________;

e) Petitioner’s Height: ____________ feet __________ inches;

f) Petitioner’s Weight: _________________________ pounds;

g) Petitioner’s Hair Color: ________________________________;

h) Petitioner’s Eye Color: ________________________________;

i) Petitioner’s Race: ________________________________;

j) Petitioner’s Sex as recorded on Birth Certificate: ________________________________;

k) Petitioner’s Date of Birth: __________/__________/___________;

l) Petitioner’s Place of Birth: ___________________, ____________;

m) Petitioner’s Hospital Location of Birth: ________________________________;

n) Petitioner’s Reason for Name Change: ________________________________;

IT IS THEREFORE ORDERED that, with all appropriate information provided to the Court and the Court having found that a name change for the Petitioner is in properly before the Court, the Petitioner shall henceforth be known as ____________________________________ (Petitioner’s New Name).

IT IS FURTHER ORDERED BY THE COURT that the Registrar of the State of _______________ shall establish a new certificate of birth for the Petitioner as a person born in this State upon receipt by said Registrar of a notarized affidavit by a licensed physician or surgeon or appropriate osteopathic doctor stating that the Petitioner has undergone a completed sex change, by way of surgery or such comparable treatment, subject to further investigation and verification by said Registrar through the appropriate medical persons. (Use This Paragraph In The Case Of Sex Change Only)

_______________________________________

Copies to: ____________________ (Judge of the _____________ Judicial District)

____________________

____________________ In And For the State of __________________.

____________________

The form above is an example of how a typical Checklist form may be completed.

The name of the testator is indicated. This should be the testator's full name.
The date of the testator's will is noted because this Checklist is a guideline.
The full names of the witnesses should be set forth, including addresses if known.
The name of the Notary Public since the notary in many states will serve as a substitute witness to the individual witnesses.
The place of signing verifies the identity of the location where the will was signed. A full address should be indicated.
The full name of the testator is provided.
The age of the testator should be set forth.
The date of birth of the testator is indicated for past record verification.
The complete address of the testator should be set forth.
The name, address, and phone number of the testator's spouse should be indicated.
The names of any children of the testator should be set forth. In the instance where there are several children, they should all be identified with full names, addresses, and phone numbers.
The identity of the parents of the testator should be set forth with particularity.
Any brothers and sisters of the testator should be identified with names, addresses, and phone numbers.
Any additional relatives of the testator should be set forth. The relationship of the relatives to the testator should be indicated.
If the executor is related to the testator, the relationship should be identified.
The personal property of the decedent should be identified. In this case, a bank account was identified.
Any additional personal property, such as other accounts, may be identified.
The listing of the certificates should be set forth.
The name of a stockbroker, along with the address and phone number of the stockbroker.
The full number of shares should be set forth.
The valuation for the stock should be set forth, including a particular time for the valuation.
Information regarding any bonds held by the testator should be provided.
The amount of any bonds should be set forth. Generally, and face value is noted.
If the bonds were cashed, it should be indicated. The amount received for the bonds should also be included.
Any jewelry should be identified.
The value of the jewelry should be provided.
Automobiles should be identified with particularity.
The year of each vehicle should be noted.
The license of each vehicle should be provided, along with the state in which the vehicle is licensed.
The value of each vehicle should be indicated.
Any equipment owned by the testator should be identified.
The location of the equipment by address or by identity of the individual who may have possession of the equipment.
The value of the equipment should be set forth.
Any commodities owned by the testator should be identified.
The amount of the commodities should be indicated.
The location of the commodities should be set forth with as much particularity as possible.
Due to the fluctuation of commodities, the value in most cases would be the value at the time of death.
The identity of any livestock.
The location of any livestock should be set forth with particularity.
The value of the livestock should be provided.
The address of the residence of the testator should be provided.
The legal description of the property, if available, should be set forth.
The value of the property should be indicated.
Any other real estate owned by the testator should be noted.
The legal description of other real estate should be set forth.
The value of the real estate should be noted.
The full name of the executor should be set forth.
The full address of the executor should be provided.
The amount of bond, if bond is required, should be noted.
The name of the bonding company should be provided.
The address of the bonding company.
The phone number of the bonding company.
The name of the attorney.
The address of the attorney.
The phone number of the attorney
The name of the court where the probate occurs.
The street address of the court.
The state in which the court is located.
The identity of any creditors.
The address of any creditors.
The number of accounts and any amounts that may be due.
The names of any care providers.
The addresses of any care providers.
The phone numbers of any care providers.
The amounts due to the decedent which may not have been identified in the earlier part of this Checklist. This form, or a similar one, is generally used by attorneys during the initial conference and may be somewhat dated. Consequently, this section usually serves as a catchall when certain items have not been set forth.
The address of the individual completing this form.
The phone number of the individual completing this form.

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This is not a substitute for legal advice. An attorney must be consulted.