Instructions For Changing the Name of an Adult
1. e process of applying for a name change involves lling out court forms, appearing before a judge, and
may also involve notifying third-parties. If you do not understand how to ll out the forms and follow
the court procedures, you should talk to a lawyer.
2. e Application for Change of Name of an Adult must be led in Judge-in-Chambers, Superior Court of
the District of Columbia Superior Court, 500 Indiana Ave. NW, Room 4220, Washington, DC 20001.
3. e completed Application must be accompanied by:
• Proof of current residence in the District of Columbia
• Valid photo identication
• Supporting Documentation
• An original or certied copy of
Applicant’s birth certicate
• Marriage certicate
• Divorce decree
• Previous name change orders
• Certicate of Citizenship
• Certicate of Naturalization
5. Applicants must be current residents of the District of Columbia, regardless of where they were born.
6. e following are some examples of what may be accepted to establish DC residency:
• Utility Bill (water, gas, electric, oil, or cable) issued within the last 60 days
• Telephone Bill issued within the last 60 days
• DC Property Tax Bill issued within the last 12 months
• Letter with picture from Court Services and Oender Supervision Agency (CSOSA) or DC
Department of Corrections verifying the Applicant’s name and residence
• Pay stub or W-2
• Home Security System Bill issued within the last 60 days
• Supplemental Security Income benets notication issued within the last 12 months
• Bank Statement issued within the last 60 days
7. When determining residency, the Court may require additional documentation.
8. Valid photo identication may not be expired and may include:
• Driver’s license
• ID Card
• Passport
4. Other supporting documentation may be required by the Court, such as:
10. e Judge-in-Chambers sta will make copies of all documents submitted for the Court record
and will return all originals or certied copies to the Applicant.
11. e cost of ling an Application for Change of Name of an Adult is $60.00.
12. e Applicant must provide the reason(s) for a change of name.
13. e Applicant will be provided with an Order and Notice of Final Hearing date and time.
9. Certied translations must be submitted for all foreign language documents. e translator
must certify that s/he is competent to translate and that the translation is accurate.
• e certication format should include the translator’s name, signature, address, and date
of certication.
• A suggested format is:
Certication by Translator
I [typed name], certify that I am uent (conversant) in the English and [enter appropriate
language] languages, and that the above/attached document is an accurate translation of
the document attached entitled [enter title of document].
Continued
14. Within ten (10) days of ling the Application, the Applicant must serve personally, or by
registered/certied mail (return receipt requested), a copy of the Application and the Order
and Notice of Final Hearing on their creditors and on each interested party as designated
by the Court.
16. Before the Final Hearing, the Applicant must le an Adavit/Declaration of Service for
each interested party and creditor (including any return receipts).
15. Examples of creditors include:
• Mortgage Companies
• Landlords
• Student Loan Companies
• Finance Companies
• Loan Companies
• Credit Card Companies
(even if there is a zero balance)
• Utility Companies
17. Even if the Applicant’s credit card company has issued a credit card in the Applicant’s
requested name, the Applicant still must notify this creditor of the requested name change
by registered/certied mail (return receipt requested) and must le an Adavit/Declaration
of Service prior to the Final Hearing.
18. If the Applicant has been convicted of a felony, or is on probation, parole, or supervisory
release in any jurisdiction, including the District of Columbia, the Applicant must serve the
appropriate law enforcement agencies or ocials either personally or by registered/certied
mail (return receipt requested). An Adavit/Declaration of service must be
led before the Final Hearing.
• Signature
• Typed Name
• Date
• Address
• Phone Number
• Email
Continued
19. If the Applicant is currently incarcerated, but was a resident of the District of Columbia
immediately prior to incarceration a name change application may be processed remotely.
Residency prior to incarceration must be established through supporting documentation.
Examples of supporting documentation are: a letter from the Applicant’s current case worker
explaining their residency status prior to incarceration, or copies of documents from their
criminal case showing the Applicant’s address prior to incarceration. Applications should
be mailed to Judge-in-Chambers, Superior Court of the District of Columbia Superior
Court, 500 Indiana Ave. NW, Room 4220, Washington, DC 20001. Additional information
or notications may be required by the Court. e Final Hearing will be conducted by video
or telephone conference, and coordinated with the appropriate facility.
20. If the Applicant has an ongoing bankruptcy case, or has been the subject of a bankruptcy,
receivership, or insolvency proceeding, the Applicant must notify the appropriate bankruptcy
court personally or by registered/certied mail (return receipt requested). An Adavit/
Declaration of Service must be led prior to the Final Hearing. When ling the Application
for Change of Name of an Adult, the Applicant must le a copy of the Discharge Order, if
one exists.
21. If the Applicant fails to notify an interested party or appear for the Final Hearing, the
Application for Change of Name of an Adult may be denied/dismissed without prejudice.
22. If any person desires to oppose the Application for Change of Name of an Adult, that person
or their attorney must be present at the Final Hearing or must le a written detailed
objection in Judge-In-Chambers at least ve (5) business days in advance of the Final Hearing.
If a written objection is led, it also must be served on the Applicant or Applicant’s counsel.
23. e approval of the Application for Change of Name of an Adult requires a Final Hearing
which will be held before the Judge-In-Chambers.
24. If an Application for Change of Name of an Adult is granted, the applicant will be provided
at least ve (5)certied copies of the Order for Name Change of an Adult. Requests for
additional copies as appropriate may be made at the Final Hearing.
Aug 2017
Civil Division
Applicant’s Current Name Being Used
Case Number
I, Applicant, respectfully represent to the Court:
1. I am an adult born on the day of
in
2. I presently reside at
3. I am seeking a change of name
4. Social Security Number:
5. Occupation:
Location: 500 Indiana Avenue, NW
Room 4220 4th Floor
Washington, DC 20001
Superior Court of The District of Columbia
Application for Change of Name of an Adult
PLEASE PRINT
Applicant’s Current Full Legal Name
Permanent Address
City, State, Zip Code
Telephone Number
First Middle Last
Place of Birth
Address Line 1
Day Month Year
Pursuant to Superior Court Civil Rule 205 and DC Code §§ 16-2501, 16-2503
to:
for the following reason(s):
Same as above or:
Same as above or:
Address Line 2
7. Has your name previously been changed? YES NO (If yes, give all previous name(s), all name
changes, and the date(s), place(s), and reason(s)).
8. Have you been known by or used a name other than the name you desire to assume? YES NO
(If yes, give all such name(s), date(s), place(s), and reason(s)).
10. Are you involved in any ongoing case(s) YES NO
(If yes, give case number(s), case caption(s), state(s), name(s) of court(s), and circumstances).
11. Is there any open or closed court case involving a decedent’s estate, probate matter, guardianship,
conservatorship, trust, heirship, duciary power, patent, trademark, copyright, goodwill, privacy,
partnership, corporation or other person, entity or proceeding that may be aected by the requested
change of name? YES NO (If yes, give case number(s), names of person(s) or
business(es) involved, states(s), name of court(s), and circumstances).
If you require additional space, please attach separate sheets of paper.
9. Are there any Child Support Orders, in any jurisdiction, that may be aected by the requested change
of name? YES NO
Case Number(s):
State(s):
6. Father’s full name:
(As it appears on Applicant’s Birth Certicate)
Mother’s full name:
Other Parent’s full name:
(As it appears on Applicant’s Birth Certicate)
(As it appears on Applicant’s Birth Certicate)
16. Are you currently registered or required to register as a sex oender in any jurisdiction? YES
NO (If yes, give specics including the state(s), name(s), and address(es) for the agency(ies)
maintaining the registry(ies)).
15. Are you on probation, parole, or supervised release in any jurisdiction? YES NO (If yes, give specics
including the supervising agency, name, telephone number, and address for person to
whom you report).
13. Have you ever been the subject of a bankruptcy, receivership, or insolvency proceeding? YES
NO (If yes, give case number(s), state(s), name of court(s), and circumstances).
If you require additional space, please attach separate sheets of paper.
14. Have you ever been convicted of a felony in any jurisdiction? YES NO (If yes, give case
number(s), state(s), name of court(s) and circumstances).
17. Are you currently registered or required to register as a gun oender in any jurisdiction? YES
NO (If yes, give specics including the state(s), name(s), and address(es) for the agency(ies)
maintaining the registry(ies)).
12. Is there any open or closed administrative or public agency proceeding that may be aected by the proposed
change of name? YES NO (If yes, give case number(s), name of agency(ies), and circumstance(s)).
THE APPLICANT HEREBY CERTIFIES THAT (1) THIS APPLICATION HAS NOT BEEN FILED FOR ANY FRAUDULENT
OR UNDISCLOSED PURPOSE AND (2) THE GRANTING OF THE APPLICATION WILL NOT INFRINGE UPON THE
RIGHTS OF OTHERS RELATING TO ANY PARTNERSHIP, CORPORATION, PATENT, TRADEMARK, COPYRIGHT,
GOODWILL, PRIVACY OR OTHERWISE.
Sworn to and subscribed before me on this day of
Signature of Applicant:
Signature of Applicant:
OR
I, the Applicant, declare under penalty of perjury under the law of the District of Columbia that
the foregoing is true and correct.
Executed on this the day of , 20 .
Signature of Notary Public
Commission Expires
Deputy Clerk Signature
19. List name(s) and address(es) of any creditor(s), including mortgage(s), loan(s) and credit card
companies, even if there is a zero balance:
Aug 2017
18. Has a Judgment or Decree ever been entered against you in any jurisdiction? YES NO
If yes, has the Judgment or Decree been paid or satised?) YES NO (Give the case, number(s)
date(s), state(s), and circumstances).
If you require additional space, please attach separate sheets of paper.
Upon consideration of the Application for Change of Name of an Adult, led by
on requesting
an order changing Applicant’s name to
,
it is by the Court this day of , 20 , hereby
ORDERED, that the Final Hearing on this Application for Change of Name of an Adult will be held in
Judge-in-Chambers, Superior Court of the District of Columbia, 500 Indiana Ave. NW, Room 4220,
Washington, DC 20001, on the day of , 20 , at : am/pm.
Applicant’s creditors
Civil Division
Superior Court of The District of Columbia
Order and Notice of Final Hearing
Pursuant to Civil Rule 205 and DC Code §§ 16-2501, 16-2503
Case Number
Location: 500 Indiana Avenue, NW
Room 4220 4th Floor
Washington, DC 20001
Judge’s Signature
Judge’s Name
Aug 2017
If any person desires to oppose this Application, that person or their attorney must be present at the
Final Hearing, or le written detailed objection ve (5) days in advance of the hearing with Judge-in
Chambers and serve a copy on the Applicant or Applicant’s counsel; and it is further
ORDERED, that within ten (10) days of ling, Applicant must serve the Application for Change of Name
of an Adult and this Order and Notice of Final Hearing personally or by registered/certied mail (return
receipt requested) on:
Check all that apply
D.C. Metropolitan Police Department
D.C. Department of Corrections
Court Services and Oender Supervision Agency
Applicant’s current probation, parole, or supervisory release ocer
Appropriate law enforcement agencies or ocials in
Bankruptcy court
Other:
Upon consideration of the Application for Change of Name of an Adult, and the entire record herein, it is by the
Court this day of 20 , hereby
Civil Division
Superior Court of The District of Columbia
Order For Change of Name
Pursuant to Civil Rule 205 and DC Code §§ 16-2501, 16-2503
Aug 2017
ORDERED, that the Application for Change of Name of an Adult is
Judge’s Signature
D.C. Metropolitan Police Department
The clerk shall send copies of this order to:
Shall be known as
ORDERED, that
DENIED; and it is further
GRANTED; and it is further
Judge’s Name
D.C. Department of Corrections
First Middle Last
First Middle Last
Court Services and Oender Supervision Agency
Other:
Case Number
Location: 500 Indiana Avenue, NW
Room 4220 4th Floor
Washington, DC 20001
Name(s) of Person(s) Served Address Date Mailed
I declare under penalty of perjury under the law of the District of Columbia that the foregoing is
true and correct. Executed on this the day of , 20 .
Subscribed and sworn to before me this day of , 20 .
I, applicant applicant’s
counsel, being duly sworn, state that my address is .
I further swear that I served the Order and Notice of Final Hearing and the Application for Change of
Name of an Adult on the person(s) named below by placing in an ocial depository of the United States
Postal Service a copy of the Notice of Final Hearing and the Application to Change Name in an envelope,
postage prepaid by certied or registered mail. I further swear that I have attached the receipts of
mailing to the person(s) listed below and that all mailing(s) were made within 10 days of the ling of the
Application for Change of Name of an Adult.
Civil Division
Location: 500 Indiana Avenue, NW
Room 4220 4th Floor
Washington, DC 20001
Superior Court of The District of Columbia
PLEASE PRINT
Adavit / Declaration of Service by Mail
(For Change of Name of an Adult Cases)
Case Number
Applicant’s Current Full
Legal Name
First Middle Last
Telephone Number:
Telephone Number:
Applicant’s Signature
Applicant’s Counsel’s Signature
OR
OR
Aant’s Signature
Notary Public
Aug 2017
I, , age 18 or older, residing or working
at , with telephone
number(s) of am not a party and have no interest in this case.
On , 20 , at AM/PM I served a copy of the Application for
Change of Name of an Adult and Order and Notice of Final Hearing personally on
Below, you must set forth specic facts from which the Court can determine that process was served as
indicated above, including a physical description (approximate age, height, weight) of any person on
whom service was made:
Civil Division
Location: 500 Indiana Avenue, NW
Room 4220 4th Floor
Washington, DC 20001
Superior Court of The District of Columbia
PLEASE PRINT
Adavit / Declaration of Personal Service
(For Change of Name of an Adult Cases)
Case Number
Aant’s Signature
I declare under penalty of perjury under the law of the District of Columbia that the foregoing is true
and correct. Executed on this the day of , 20 .
Process Server
Aant’s Signature
Notary Signature
Subscribed and sworn to before me this day of , 20 .
OR
Aug 2017
Applicant’s Current Full
Legal Name
First Middle Last
