Name Change Questionnaire

KENNETH VERCAMMEN & ASSOCIATES, PC

ATTORNEY AT LAW

2053 Woodbridge Ave.

Edison, NJ 08817

(Phone) 732-572-0500

Legal Fee $1,900, due within 7 days

Consult only $150

Name Change Questionnaire

NAME __________________________________________________

ADDRESS ______________________________________________

CITY ______________________ STATE ____ZIP _____________

CELL-PHONE ___________________________________

E-MAIL ADDRESS ___________________________________________

1. Applicant is the plaintiff and resides at the address:___________

2. The applicant is a citizen of the United States of America. YES___   NO___

3. Plaintiff's social security number is __________.

4. Applicant was born on __________ at __________.

5. Applicant is the son/daughter  of ______ and ______ (A copy of the birth certificate is attached).

6. Plaintiff was raised by _______________.  Applicant's current occupation is that of ______________.

7.      Plaintiff has since childhood been identified by the name of ____________________

8. Has Applicant been married?  YES___  NO____

9. No judgments have ever been recovered against the applicant; no bankruptcy or insolvency proceedings have been instituted affecting the applicant; and no suits are now pending against the applicant. Yes___ No_____                 [rev 9/18/14]

10. Applicant has not been convicted of a crime within the last 10 years. There are not any criminal charges pending against applicant. Therefore, no notice is required to the County Prosecutor or Attorney General.  Yes___ No_____

11. This application is not made with the intent to avoid creditors or criminal prosecution or for other fraudulent purpose.  Yes___ No_____

12.  Plaintiff - has ___    has not ___ made previous application to assume another name.

13. Applicant desires to change applicant's name to _________

14. Plaintiff requests this name change for the following reasons:

A. ___________________________________________

_____________________________________________

_____________________________________________

___________________________________________

Name Change : SERVICES TO BE PROVIDED AND LEGAL FEE

1. Office interview with client, office consult fee is $150.00, which is included in the Name Change fee.  2. Review Name Change Questionnaire filled out by client. 3. Obtain information such as name, address and telephone number.

4. Obtain information regarding details of Name Change

5. Attend to opening of file.

6. Preparation of draft Verified Complaint Including Certification of Plaintiff for Name Change

7.      Preparation of Order Fixing Date of Hearing for Name Change

8. Prepare letter to client enclosing drafts for client to carefully read.

9.      Preparation of Newspaper Notice

10.    Preparation of letter to The Home News & Tribune

11.    Preparation of Final Judgment for Name Change

12.    Travel to County Courthouse and appearance in front of Superior Court Judge

13.    Preparation of letter to Department of Treasury

14.    Preparation of letter to Vital Statistics

15.    Preparation of letter to Motor Vehicle Commission DMV with Judgment

16.    Office conference with client

17. Provide free information brochures on Wills, Power of Attorney, Living Wills, Answers to Questions about Probate, Website/ Elder Law on the Internet website www.njlaws.com other brochures.

18. Provide bi-weekly computer email newsletter with updates on Probate, Insurance, and Free Legal Information.

19. Preparation of end of case letter to client

Legal fee for Name Change- $ 1,900 includes court appearance.

Please make Checks payable to Kenneth Vercammen, PC.   Visa, Master Card and American Express accepted. Please pay the front desk legal secretary at first meeting.  Payment is required prior to any documents being drafted.

Other costs: Superior Court Filing Fee $200.00 Payable to Superior Court of NJ

Newspaper Publication Fees $ _________ Depends on newspaper

The newspaper will send a bill and you prepare a check payable to newspaper, not to exceed $190.  Usually the Home News Tribune

Check for $10.00 payable Treasurer, State of NJ for certified copies after Order granted

Department of Treasury $50  Payable to Department of Treasury to file

Please write out checks and give to law office. These checks are needed to file documents. This is not included in the legal fee.

[Note- After the Complaint is typed, there is a minimum $50.00 additional charge for each change  not set forth in the Questionnaire filled out by clients at the initial consult.  The Complaint needs to be signed within 21 days of initial consult or additional fee will be charged. There is an additional $50.00 charge for canceled, rescheduled, or missed signing appointments.   The fee paid is non refundable.

Name Change
New Jersey Rules and statute have set up a detailed procedure for someone to legally change their first name, last name or both. Using an experienced attorney, you can have a new name approved by the Superior Court with only one court appearance. Sections 2A:52-1 et seq. of the New Jersey Statutes, and Rule 4:72 of the New Jersey Court Rules set forth certain legal requirements your attorney most follow. The following information must be provided by you to your attorney so it can be supplied to the Court by way of Complaint. 1. Current name and address _______ 2. Age of ____ years and was born on ____ at ____ New Jersey, parents ____ (attach a birth certificate) 3. Applicant’s current occupation is that of ____. . 4. The applicant is a citizen of the United States of America. 5. Marriage status 6. Children _____- 7. The name and residence of applicants nearest living relative is ____ 8. No judgments have ever been recovered against the applicant; no bankruptcy or insolvency proceedings have been instituted affecting the applicant; and no suits are now pending against the applicant. 9. No previous application has ever been made by the applicant for leave to assume another name. 10. Applicant desires to change applicants name to ____________ for the following reasons: A. ____ ____ ____ ____ ____ ____ ____ ____ ____ 11. This application is not made with the intent to avoid creditors or criminal prosecution or for other fraudulent purpose. 12. Applicant has never been convicted of a crime. 13. There are not any criminal charges pending against applicant. Therefore, no notice needs to be served on the County Prosecutor or Attorney General. 14. The social security number is ____ FILING THE COMPLAINT The complaint must be signed by the applicant in front of their attorney. Your attorney will prepare a Order Fixing Hearing for Name Change. The complaint and Order are filed in the Superior Court. The Order will be signed by the Judge setting forth the date to come to court and other legal requirements, such as publication and notice. Your attorney will submit the Order for Hearing to be published in a newspaper of general readership, such as the Home News Tribune. Proof of publication must be filed with the court. A proposed Judgment for Name Change is forwarded to the Judge to be signed if the approved. HEARING AND JUDGMENT FOR NAME CHANGE On the date selected by the Court the matter will be opened to the Court on the Complaint of the Plaintiff, the plaintiff having appeared by their attorney seeking a judgment allowing him/her to assume the new name. Following questioning of the applicant and it appearing from the Verified Complaint that the plaintiff complied with the requirements of the statute in such case made and provided, and it further appearing that after notice of the hearing was duly published, no reasonable objections were made thereto, and for good cause appearing, the Court should approve the name change. However, the work by your attorney is still not done. The Judgment for Name Change must be signed the Judge. Your attorney shall cause to be published in the Home News & Tribune or another newspaper a copy of the Judgment; Within 20 days after the entry of the Judgment, your attorney will cause to be filed a certified copy of the judgment, together with an affidavit of publication, with the Clerk of Middlesex County, as well as the Secretary of the State of New Jersey, pursuant to the statute and rules. The Applicant should forward copies of the Courts Judgment for Name Change to change their name on legal documents and identification such as Drivers License, Social Security Card and birth certificate. Name change statute in 2002 2A:52-1. Action for change of name 2A:52-1. Any person may institute an action in Superior Court, for authority to assume another name. The complaint for a change of name shall be accompanied by a sworn affidavit stating the applicants name, date of birth, social security number, whether or not the applicant has ever been convicted of a crime, and whether any criminal charges are pending against him and, if such convictions or pending charges exist, shall provide such details in connection therewith sufficient to readily identify the matter referred to. The sworn affidavit shall also recite that the action for a change of name is not being instituted for purposes of avoiding or obstructing criminal prosecution or for avoiding creditors or perpetrating a criminal or civil fraud. If criminal charges are pending, the applicant shall serve a copy of the complaint and affidavit upon any State or county prosecuting authority responsible for the prosecution of any pending charges. A person commits a crime of the fourth degree if he knowingly gives or causes to be given false information under this section. Amended 1981,c.362,s.1, 1993,c.228,s.1. 2A:52-2. Effect of judgment, copy to State Bureau of Identification 2A:52-2. Such person, from and after the day specified therefor in the judgment in the action, shall be known by the name which, by the judgment, he is authorized to assume, and by no other. The judgment for change of name shall include the applicant’s social security number and date of birth. The clerk of the court shall forward a copy of the judgment to the State Bureau of Identification in the Division of State Police if the person has been convicted of a crime or if there are criminal charges pending against him. Amended 1981,c.362,s.2; 1993,c.228,s.2. 2A:52-3. Effect of change of name on actions or other proceedings No action, or other legal proceeding commenced in his former name against any person whose name shall have been changed pursuant to the provisions of this chapter shall, by reason of such misnomer, be abated, nor shall any relief of recovery sought thereby be prevented. 2A:52-4. Correction of record of birth or marriage Upon the receipt of either of the following documents: a. A certified copy of a judgment permitting a change of name; or b. A certification issued in connection with a naturalization proceeding authorized by Act of Congress that a change of name was permitted by decree or order of a court vested with jurisdiction to naturalize persons as citizens of the United States; together with a request for correction of an existing record of the birth or marriage of the individual, the State Registrar of Vital Statistics or local registrar of vital statistics shall adjust the record or records to show the new name and the date and manner by which obtained. When the request and such copy or certification are received by a local registrar, he shall forward them to the State Registrar after having adjusted his local record. In the event the name of any child or children shall be permitted to be changed in the naturalization proceedings of the parent of such child or children, the certification of the parents naturalization record or proceedings disclosing such change of name of such child or children shall be sufficient authority for the State Registrar of Vital Statistics or the local registrar, as the case may be, upon request, to correct the birth certificate or marriage certificate of such child or children in the same manner as provided for the correction of the parents birth certificate or marriage certificate. The fee to be paid a local registrar or the State Registrar for each birth certificate or for each marriage certificate so corrected shall be $2.00. Any certified copy of a record changed as provided for in this chapter shall show the name at birth or marriage and the new name and date and manner by which obtained, but upon request shall show only the new name. Amended by L.1955, c. 249, p. 927, s. 1; L.1958, c. 81, p. 521, s. 1, eff. June 24, 1958; L.1983, c. 275, s. 1, eff. July 18, 1983.