Form Cc 1412 PDF Details

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QuestionAnswer
Form NameForm Cc 1412
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesvirginia form cc 1412, virginia formcc1412, form cc 1412, cc 1412 order change name

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ORDER FOR CHANGE OF NAME (ADULT)

Case No

Commonwealth of Virginia VA. CODE §§ 8.01-217, 20-121.4

 

VIRGINIA: In the Circuit Court of the [ ] City [ ] County of .........................................................................................

IN RE:

This day came the applicant having filed his/her verified application requesting the change of his/her name from

....................................................................................................................................................................................

FIRST

MIDDLE

LAST

SUFFIX

 

 

to

 

....................................................................................................................................................................................

 

FIRST

MIDDLE

LAST

SUFFIX

Additional former name(s) of the applicant:

 

The applicant’s address is:

 

 

[ ] The Court finds that

 

 

 

[

] the application complies with the requirements of subsection B of Virginia Code § 8.01-217,

[

] a motion was made pursuant to Va. Code § 20-121.4 incident to divorce,

 

the change of name is not sought for any fraudulent purpose, and the change of name would not otherwise infringe upon the rights of others.

[ ] The Court previously found that the applicant is presently incarcerated, a probationer, or a person for whom registration with the Sex Offender and Crimes Against Minors Registry is required but found good cause for consideration of the application and conducted a hearing on the application.

[ ] The Court finds that the change of name would not frustrate a legitimate law enforcement purpose, is not sought for a fraudulent purpose, and would not otherwise infringe upon the rights of others. The basis for this finding is as

follows: .....................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

Accordingly, it is ADJUDGED and ORDERED that

[ ] The applicant’s name is hereby changed, effective this date, to

....................................................................................................................................................................................

and this cause is ended.

[ ] The Clerk of this Court shall forthwith spread this Order upon the current deed book, indexing the order in both the old and new names.

[ ] The Clerk of this Court shall further transmit a certified copy of this Order and the application to the State Registrar of Vital Records and to the Central Criminal Records Exchange.

[ ] This change of name is granted incident to a divorce and the Clerk shall not transmit any copy of this Order to the Registrar of Vital Records or to the Central Criminal Records Exchange.

[ ] Public recording of the name change would pose a serious threat to the health or safety of the applicant/applicant’s family and the record of this cause is hereby Ordered sealed. The Clerk shall not spread or index this Order and shall not transmit any copy of this Order to the Registrar of Vital Records or to the Central Criminal Records Exchange.

[ ] The application for change of name is hereby denied and this cause is dismissed.

Entered this

day of

......................................................................, 20

 

 

_____________________________________________________________________

 

 

JUDGE

FORM CC-1412 MASTER 07/14