eForm: Petition for Change of Name of Minor Child
*Caution: this form requires protected information and the filing of a separate Protected Information Form.
In the Iowa District Court for ________________ County
In re the Name Change of:
*___________________________________
A minor child
Petition for Change of Name
of Minor Child
If you need assistance to participate in court due to a disability,
contact the disability coordinator (information at
www.iowacourts.gov/Representing_Yourself/ADAAccess).
Persons who are hearing or speech impaired may call Relay
Iowa TTY (1-800-735-2942). Disability coordinators cannot
provide legal advice.
I (We), ______________________________________________________________________,
as parent(s) of *_____________________________, a minor child, for this Petition for Change
of Name of Minor Child under Iowa Code chapter 674, state:
1. Check either A., B., or C:
A. I
am the sole parent qualified to act on behalf of the minor child and that
parent
al rights of the other parent have been terminated or there is no other legally
established parent;
B. T
he other parent has not consented to the minor child’s change of name; or,
C. We (
both parents) consent to the minor child’s change of name.
*2. T
he minor child’s present full name is __________________________________________,
and the minor child resides in _____________________ County, Iowa.
*3. The minor child’s date of birth is ________________________________ (month, day,
year), and the minor child is therefore (check either A. or B.):
A. Under fourteen (14) years of age and (check only one of the following):
1. Bot
h parents, as listed on the minor child’s birth certificate, consent to
the
minor child’s change of name upon verifying and filing this petition;
2. I will serve notice of hearing to the non-consenting parent pursuant to the
Iowa Rules of Civil Procedure;
3. I will provide adequate proof that the non-consenting parent has
abandoned the minor child;
4. I will provide adequate proof that the non-consenting parent has been
ordered to contribute to the support of the child or to financially aid in the child’s
birth and has failed to do so without good cause; or
5. I will provide adequate proof that the non-c
onsenting parent does not
objec
t to the name change after having been given due and proper notice.
B. Fourteen (14) years of age or older and a written consent of
the child is filed
with t
his petition.
4. The minor child is ____ feet, ____ inches tall; weighs______ lbs.; has __________ color
hair; and _____________ color eyes.
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