Name Change Information Form
Use this form for a name change for an American Citizen - either:
- A single adult individual or
- A child with the consent of both parents.

Please contact the office at (845)709-6060 if you are not an American Citizen, seek multiple name changes or do not have the consent of both parents.

Please Be Sure to Click "SUBMIT" At the End of the Form!!!!

Current Name *
This is your current name as listed on your birth certificate
Your answer
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