Civil Court of the City of New York

Adult Name Change Petition Program

Because of your answers to the program, these are the documents you need:

Instructions for how to complete and how to file your Name Change Petition
AName Change Petition

Fee Waiver Affidavit

NYS DIY Forms User Survey
Instructions for how to complete
And how to file the Name Change Petition

1. Read the Petition carefully. Make sure that all the information you gave is correct.
Fix any mistakes before you print the Petition.
2. Do not fill in the Index No. at the top. Its in the right hand corner. That will be
done at the courthouse.
Notarization and Verification
1.
2.
3.
4.

Take the Petition to a Notary Public.

Sign the Petition on the blank line above your name.
Write the date that you are signing the Petition on the blank line that says Date.
After you do this, read the Verification. The Verification says that you have read the
Petition and the words are true. If this is true, sign the Verification on the blank line
above your name. Dont sign it before you get to the Notary Public because they
have to see you sign it. The Notary will fill in the county, date and notarize the
Petition.

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Documents and Proof to Bring to Court

1. You must prove the date and place where you were born. If you were born in the
State of New York you must attach a certified copy of a Birth Certificate, it will have
a raised seal (a bumpy logo) of the local government agency, or bring a Certificate
from the Commissioner or the local Board of Health that no such Certificate is
available.
If you were born in the City of New York, you can get a certified copy of

your birth certificate from the Office of Vital Records, Department of

Public Health, 125 Worth Street, New York, New York 10013.
If you were not born in New York City, but in the State of New York, you

can get a certified copy of your birth certificate from your local City Hall for
$15.00. It takes about two weeks by mail. Or you can get it from the New
York State Department of Health, Empire State Plaza, Albany, New York
12237. The cost is $30.00 and takes about 10 weeks by mail.
2. If you have been convicted of a crime and you served your sentence, you can
choose to attach a copy of the Certificate of Incarceration or Certificate of
Disposition.
3. If you have had bankruptcy, you can choose to attach a copy of the judgment along
with the Petition.
4. If you have any legal judgments or liens, you can choose to attach copies to the
Petition.
5. If you are a part of any other court cases, you can choose to attach copies of the
court papers.
6. Remember that any documents you give to the court will be part of the court record
and you will not get them back, so make copies before coming to the courthouse.
7. The Judge can require that you give copies of any of the documents on this list.
8. The Judge may ask for additional information or documents that are not on this list.
9. You may have to prove your income. Proof of income is a paper or papers that show
how much money you make every month. Proof of income can be copies of your:
Work pay stubs
Most recent income tax return
Social Security Proof of Income letter
Public assistance benefits card
Pension benefits letter
Unemployment benefit letter
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Workers Compensation benefit letter

Filing the Petition and Publication

1. Make a copy of the Petition and Fee Waiver Affidavit for yourself.
2. Bring your completed name change Petition, Fee Waiver Affidavit, the completed
NYS DIY Forms User Survey, and the documents on the list to the Civil Clerks
Office in the courthouse located at: 111 Centre Street, County of New York.
3. If your papers are correct, the Clerk will file your Petition with the Court. If the
Judge does not give you a fee waiver, you will have to pay the filing fee of $65.00 for
your name change application. If you do not pay, your name change application will
not be considered. The fee must be paid by cash, certified check, money order or
bank check. Personal checks will not be accepted.
4. A Judge will read your papers and decide yes or no to allow the change of name.
5. If the Judge agrees to your name change Petition, you will have to put a notice of the
change of name in at least one newspaper that the Court approves. The
newspaper(s) will charge you a fee for this service.
6. The Judge can also require that you tell other parties like:
United States Citizenship and Immigration Services
Selective Service System
Your wife or husband (if you are only changing your name)
An ex-wife or husband
Bankruptcy Court
New York State Criminal Justice Services

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Any other party the Court thinks should be notified. Civil Court of the City of New

York
County of New York
In the Matter of the Application of

Index Number__________
PETITION FOR
INDIVIDUAL ADULT
CHANGE OF NAME

DANNY XIAO YANG LIAN,

For Leave to Change His Name To

DANNY LIAN,
_____________________________________

Danny Xiao Yang Lian, by this petition alleges:

1.

My present name is Danny Xiao Yang Lian.

2.

I would like my new name to be Danny Lian, in place of my present name.

3.

I am 18 years old. I was born on September 2, 1996.

4.

I was born in NYC, NY , USA.

5.

I currently live at 651, 61Street, 7Ave, 2ND Floor, New York, NY, 11220.

6.

I have never been convicted of a crime.

7.

I have never declared bankruptcy.

8.

There are no judgments or liens against me.

9.

I am not a party to any actions or proceedings.

10.

I do not have any obligations to pay child support.

11.

I do not owe any child support.

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Petitioner for Individual Adult Change of Name

Page 4 of 5

12.

I am not responsible for spousal support.

13.

I have not made a previous application to change my name in this or any other court.

14.

I want to change my name for the following reason(s):

I don't like my middle name. It makes my name very complex. I do not want chinese name in my
middle name.

WHEREFORE, your Petitioner respectfully requests that an Order be granted permitting

this change of name.
____________________________
Date
__________________________________________
Danny Xiao Yang Lian

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Petitioner for Individual Adult Change of Name

Page 5 of 5

______________________________________________________________________________
VERIFICATION
State of New York, County of ___________________ ss.:
Danny Xiao Yang Lian, being duly sworn, deposes and says:
he is the petitioner named above, that petitioner has read the petition and knows the truth of the
contents thereof except for those matters alleged to be on information and belief, and as to those
matters, petitioner believes them to be true.
__________________________________________
Danny Xiao Yang Lian
Sworn to before me this _____ day of __________, 20____
______________________________________
Signature of Notary Public

CIVIL COURT OF THE CITY OF NEW YORK

COUNTY OF NEW YORK
In the Matter of the Application of
DANNY XIAO
YANG LIAN,
For Leave to Change His Name to

Index #: ____________________

AFFIDAVIT IN SUPPORT OF
APPLICATION TO WAIVE FEES
Pursuant to CPLR 1101(d)

DANNY LIAN,
State of New York, County of ______________________ ss.:
DANNY XIAO YANG LIAN, , being duly sworn, deposes and says:
1. I am the petitioner in the above titled action.
2. I reside at 651, 61Street, 7Ave, 2ND Floor, New York, NY, 11220.
3. I submit this affidavit in support of my application for a fee waiver of the court filing
fees for my name change application.

4. I wish to change my name to DANNY LIAN, for the reasons described in my court
papers which are attached herein.
5. I support only myself and no others.
6. I receive public assistance from the Department of Social Services of the City of
New York.
7. My sources of income are as follows:
I am not currently employed.
8. My expenses include $0 a month for rent and $0 a month for utilities.
9. I want to tell the judge the following about my income and expenses:
I used to receive food stamp. My mother and my sister is recieving food
stamp.
10. My property and their values are as follows:
I have a balance of about $67.66 in my bank account.
11. I make this application pursuant to CPLR 1101. I do not have, nor am I able to
obtain, the funds needed to pay for the court fees. I will be unable to proceed unless
the Order is granted.
12. No other person is beneficially interested in the recovery sought herein.
13. I have not made a previous application for a fee waiver for my name change
application.
WHEREFORE, I respectfully ask for an order granting me a fee waiver for court
fees.
__________________________
_____
DANNY XIAO YANG LIAN
Sworn to before me this
_____ day of ________, 20_____
___________________________
Signature of Notary or Court Employee
and Title

NYS DIY Forms User Survey

Thank you for taking the time to fill out this quick survey. Please return it with your completed papers.
1. How comfortable are you using a computer and/or the internet?
Not comfortable
Comfortable
Very comfortable

2. Do you have the internet at home?

Yes.
No.

3. Where did you use this program?

Home
Court Clerks Office
Court Help Center
Court library
Work
Other: ____________________________________

4. Were the questions, definitions and learn mores clear to

understand?
Yes.
No. Which werent clear? ____________________________
_________________________________________________

5. Did you listen to the guide speak during the program?

Yes.
No.
6. Have you used a court DIY Forms program before?
Yes. Which ones? __________________________________
____________________________________________________

No.

7. Do you think the DIY program saved you time?

Yes.
No.
8. How did you learn about this program?
Word of mouth
Internet search
Court employee
Poster, sign, postcard, etc.
Other: ____________________________________
9. We really appreciate your help. Do you have any suggestions or
comments to add?
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
Optional questions:

1. How old are you?

Between 18 and 24
Between 25 and 34
Between 35 and 44
Between 45 and 54
Between 55 and 64
65 or older

2. What is your annual income?

Less than $19,999
$20,000 to $34,999
$35,000 to $49,999
$50,000 to $64,999
$65,000 to $79,999
$80,000 to $99,999
$100,000 to $124,999
$125,000 to $149,999
$150,000 or more

Office Use:
Court Clerk: Forward to the Assistant Deputy Chief Clerk of the County.
New York County NYC Civil adult name / fee waiver printed on January 17, 2015