Note: See 23 Pa.C.S. § 2904. See also Supreme Court Orphans' Court 15.5(e) where the adopted person has attained majority.
Note: While Local 205.4 does not mandate that Petitions for Name Change be filed electronically, it is permissive to do so. However, the Petition will not proceed unless the Petitioner provides the documents listed in Subsection (3)(b) below to the Department of Court Records.
PA State Police
Central Repository
1800 Elmerton Avenue
Harrisburg, PA 17110
Department of Court Records of Allegheny County
First Floor City-County Building
414 Grant Street
Pittsburgh, PA 15219
ATTENTION: Second Deputy
Note: A current listing of the fees charged by the Department of Court Records can be found on the Department of Court Records web site: https://dcr.alleghenycounty.us.
The District Attorney of Allegheny County
Allegheny County Courthouse
436 Grant Street
Pittsburgh, PA 15219
Office of the Attorney General
Commonwealth of Pennsylvania
1600 Strawberry Square
Harrisburg, PA 17120
Editor's Note: Amended November 29, 2021, effective January 11, 2022.
FORM 505A Petition for a Name Change
IN THE COURT OF COMMON PLEAS OF ALLEGHENY COUNTY, PENNSYLVANIACIVIL DIVISION
In Re the Petition of: | CIVIL DIVISION |
_____________________________________ | DOCKET No- GD- _______________ |
(Print Your Current Name) | |
For a Name Change to: | |
_____________________________________ | |
(Print Your New Name) |
VERIFIED PETITION FOR A NAME CHANGE
And now comes Petitioner(s), _______________________________________________ ___________________________________________________________by this Petition, and upon being duly sworn, respectfully represents and shows this Court:
Petitioner(s) has been a bona fide resident of Allegheny County, Commonwealth of Pennsylvania for __________year(s) immediately prior to filing this Petition. Petitioner(s) was born on the __________ day of ____________________, __________in the County of ___________________, State of ___________________, and Country of _________________.
[] None
Name | Date of Birth | Age |
______________ | ______________ | ______________ |
______________ | ______________ | ______________ |
______________ | ______________ | ______________ |
______________ | ______________ | ______________ |
______________ | ______________ | ______________ |
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Wherefore, the Petitioner(s), intending to change his/her name, requests that by an Order of this Court, made and entered herein, the Petitioner's(s') name be changed to and decreed to be:
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Respectfully submitted,
__________________
(Sign Your Current Name)
Address:___________
City, State, Zip: ___________
Telephone: ________________
VERIFICATION
I, (___________________________________________)(Print Your Current Name), verify that the statements made in the foregoing Petition are true and correct to the best of my knowledge or information and belief.
I understand that this verification is made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn fabrication to authorities, which provides that if I knowingly make false averments, I may be subject to criminal penalties.
Date: ____________________
______________________
(Sign Your Current Name)
FORM 505B(i) Order Scheduling Hearing on Name Change (used if Petition is brought by a person(s) of full legal age)
IN THE COURT OF COMMON PLEAS OF ALLEGHENY COUNTY, PENNSYLVANIA CIVIL DIVISION
In Re the Petition of: | CIVIL DIVISION |
_____________________________________ | DOCKET No- GD- _______________ |
(Print Your Current Name) | |
For a Name Change to: | |
_____________________________________ | |
(Print Your New Name) |
ORDER SCHEDULING HEARING ON NAME CHANGE
AND NOW, this __________day of ____________________, 20_____, upon hearing of the within motion of _________________________Esquire/pro se, attorney for the Petitioner(s) above named, it is ORDERED and DECREED that the within Petition be heard on the __________ day of____________________, 20_____at __________before the General Motions Judge. Petitioner(s) shall obtain a judgment search from all counties in which he/she has resided during the last five (5) years.
It is further Ordered that the Petitioner(s) shall advertise once in the Pittsburgh Legal Journal, and once in a newspaper of general circulation in Allegheny County.
BY THE COURT,
________________________, J.
IN THE COURT OF COMMON PLEAS OF ALLEGHENY COUNTY, PENNSYLVANIA CIVIL DIVISION
In Re the Petition of: | CIVIL DIVISION |
_____________________________________ | DOCKET No- GD- _______________ |
(Print Your Current Name) | |
For a Name Change to: | |
_____________________________________ | |
(Print Your New Name) |
ORDER SCHEDULING HEARING ON NAME CHANGE
AND NOW, this __________ day of ____________________, 20_____, upon hearing of the within motion of ________________________, Esquire/pro se, attorney for the Petitioner(s) above named, it is ORDERED and DECREED that the within Petition be heard on the __________ day of ____________________, 20_____ at __________ before the General Motions Judge. Petitioner(s) shall obtain a judgment search from all counties in which he/she has resided during the last five (5) years.
IT IS FURTHER ORDERED that Petitioner(s) shall obtain an affidavit of consent from the non-petitioning parent and/or serve a copy of this scheduling order by certified and regular mail forthwith.
IT IS FURTHER ORDERED that the Petitioner(s) shall advertise once in the Pittsburgh Legal Journal, and once in a newspaper of general circulation in Allegheny County.
BY THE COURT,
_______________, J.
IN THE COURT OF COMMON PLEAS OF ALLEGHENY COUNTY, PENNSYLVANIA CIVIL DIVISION
In Re the Petition of: | CIVIL DIVISION |
_____________________________________ | DOCKET No- GD- _______________ |
(Print Your Current Name) | |
For a Name Change to: | |
_____________________________________ | |
(Print Your New Name) |
DECREE FOR CHANGE OF NAME
AND NOW, this __________ day of ____________________, 20_____, upon hearing on the within Petition and upon motion of _________________________, Esquire/pro se, attorney for Petitioner(s), with proof of publication and proof that there are no judgments or decrees of record or any other matter of like effect against Petitioner(s), and it appearing that there are no legal objections to the granting of the prayer of the Petition, it is ORDERED and DECREED that the name(s) of the Petitioner(s) be and are, from and after this date changed to__________________________________________
_______________________________________
BY THE COURT,
__________________J.
IN THE COURT OF COMMON PLEAS OF ALLEGHENY COUNTY, PENNSYLVANIA CIVIL DIVISION
In Re the Petition of: | CIVIL DIVISION |
_____________________________________ | GD- _______________ |
(Print Your Current Name) | FD- _______________ |
For a Name Change to: | |
_____________________________________ | |
(Print Your New Name) |
CASE TRANSFER ORDER
AND NOW, the __________day of ___________________, 20______, the Court makes the following findings:
It is therefore ORDERED, ADJUDGED and DECREED as follows:
an existing Family Division docket number, this Petition shall be matched to the existing file and transferred to the Family Division. If there is no existing Family Division docket number, the Department of Court Records shall assign a Family Division docket number and open a case file. In either event, the above-referenced docket number shall be cross-referenced with the Family Division docket number.
Name | Address | Date of Birth |
______________ | ______________ | ______________ |
______________ | ______________ | ______________ |
______________ | ______________ | ______________ |
______________ | ______________ | ______________ |
______________ | ______________ | ______________ |
Address and telephone number of the father ______________________________________
Date of Birth of the father ____________________________________
Address and telephone number of the mother _____________________________________
Date of Birth of the mother ___________________________________
_______________________________________________
_______________________________________________
_______________________________________________
BY THE C OURT:
_________________ J.
Alle. Cnty. Pa. 505