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Application for Change of Name (Adult)

Commonwealth of Virginia Code § 8.01 - 217

Instructions

To legally change your name, please fill out the online application on the subsequent pages. Your application form and order will be generated automatically. After the forms are generated, the application must be signed under oath.

To sign the application under oath, you may either sign in the presence of a notary public, and mail your forms to the Arlington Circuit Court Clerk’s office; or you may submit the forms electronically and sign in front of a deputy clerk at the Clerk’s office.

The filing fee for a name change is $44.00. If paying by mail, please include a check or money order made payable to “Clerk of the Circuit Court.” Cash or credit card (Visa, MC and Discover) are accepted if paying in-person. Please note, credit card transactions incur a 4% convenience fee.

Please choose how you would like to proceed:

Upon completion of all fields, please select 'Email my Documents.' Your documents will be sent to the email address you provided. Upon receipt, please sign the application in front of a notary, and mail the forms along with the required payment to:

Arlington County Circuit Court
Attn: Civil Division
1425 N. Courthouse Road, Suite 6700
Arlington, VA 22201

Upon submission, you will receive a confirmation e-mail and will have 14 days to present in-person to the Arlington County Circuit Court Clerk’s office. Applicants will need to show a valid photo ID, and pay $44.00 filing fee. The Clerk’s office is open Mon. – Fri. 8am to 4pm, and is located at:

1425 N. Courthouse Road, Suite 6700
Arlington, VA 22201

I have read the instructions above and agree to pay the $44.00 filing fee. *

Application for Change of Name (Adult)

Commonwealth of Virginia Code § 8.01 - 217

VIRGINIA: In the Circuit Court of the County of Arlington

IN RE: Applicant's Present Name:

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Applicant Contact Information:

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COMES NOW, the applicant, and after being duly sworn states under oath as follows:

Copy from Applicant's Present Name

1. Applicant's Birth Name:

Applicant First Name *

Applicant First Name

Applicant First Name *

Applicant Middle Name

2. City or County of Residence:

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3. Residence Address:

Applicant First Name *

Applicant First Name

Applicant First Name *

Residence Address State *

Applicant First Name *

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address full

4. Mailing Address:
If different from Residence Address

Applicant First Name

Residence Address State

Applicant First Name

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5a. Date of Birth:

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5b. Place of Birth:

Applicant First Name *

6. Full Names of Parents

6a. Full Name:

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Applicant Middle Name

Applicant Last Name *

Applicant Middle Name

6b. Full Name:

Applicant First Name *

Applicant Middle Name

Applicant Last Name *

Applicant Middle Name

7. Reason for Name Change Application:

Applicant First Name *

Application for Change of Name (Adult)

Commonwealth of Virginia Code § 8.01 - 217

Answer the following questions by selecting 'Yes' or 'No' and providing information as requested.

8. Have you ever been convicted of a felony?

Yes

9. Are you currently incarcerated? **

Yes

Facility Name:

Applicant First Name *

Facility Location:

Applicant First Name *

Applicant First Name

Applicant First Name *

Residence Address State *

Applicant First Name *

Court(s) where convicted:

Applicant First Name *

10. Are you a probationer with any court(s)? **

Yes

Court(s) Name:

Applicant First Name *

11. Are you a person for whom registration with the Sex Offender and Crimes Against Minors Registry is required? **

Yes

Court(s) where conviction occurred that resulted in the requirement to register:

Applicant First Name *

12. Have you previously changed you name either by a prior application or by marriage?

Yes

Please note that in addition to the application and order, you must include a court order or other documentation when you mail your Name Change documents to the Arlington Circuit Court.

Previous Name(s):

Applicant First Name *

Upload court order or other documentation:

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Upload

** No application of a probationer, incarcerated person, or person for whom registration with the Sex Offender and Crimes Against Minors Registry is required shall be accepted unless the Court finds good cause exists for such application under the reasons alleged in the application for the requested change of name.

Upload explanatory documentation to the application:

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Upload

13. Is this name change pursuant to a divorce?

Yes

Please note that in addition to the application and order, you must include a divorce decree when you mail your Name Change documents to the Arlington Circuit Court.

Upload divorce decree:

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Upload

14. Does public recording of the name change pose a serious threat to the health or safety to the applicant?

Yes

Please note that in addition to the application and order, you must include both a motion to seal AND supporting documentation when you mail your Name Change documents to the Arlington Circuit Court.

Upload motion to seal:

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Upload

Upload supporting documentation:

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Upload

Application for Change of Name (Adult)

Commonwealth of Virginia Code § 8.01 - 217

I, the applicant, hereby certify that this name change is not sought for any fraudulent purpose, and request that the Court order a change of name from:

Applicant's Present Name:

Applicant First Name *

Applicant Middle Name

Applicant Last Name *

Applicant Middle Name

Applicant Full Name - Present

First Plaintiff

First and Middle - Present

Requested Name:

Applicant First Name *

Applicant Middle Name

Applicant Last Name *

Applicant Middle Name

Applicant Full Name - Requested

First Defendant

First and Middle - Requested

Email My Document to:

Question text *

After receipt of your documents, please sign the application in front of a notary, and mail the application and order to the Arlington Circuit Court.

Click Submit Application. You will be redirected to the Arlington Circuit Court website.

Click Email my Documents. You will be redirected to the Arlington Circuit Court website.

Application for Change of Name (Adult)

Commonwealth of Virginia Code § 8.01 - 217

Instructions

Application for Change of Name (Adult)

Commonwealth of Virginia Code § 8.01 - 217

Application for Change of Name (Adult)

Commonwealth of Virginia Code § 8.01 - 217

Application for Change of Name (Adult)

Commonwealth of Virginia Code § 8.01 - 217

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