Name Change Intake Form -- Law Office of Milo Primeaux, Esq.
Welcome!

So you need helping changing your name! I have assisted hundreds of transgender, non-binary, and gender-expansive people with this process in New York and other states, and I'm happy to help you, too. Fill out this form so I can assess the complexity of your case and whether I have any ethical conflicts of interest that would keep me from being able to take you on as a client.

Filling out this form does NOT create an attorney-client relationship -- it only gives me info I need to determine whether I can accept your case. If I can, I will contact you to setup an initial intake call, and I will send you an engagement letter and retainer agreement to review and sign before we move forward with the process. If I can't, I will let you know, and refer you to other attorneys or legal organizations.

ABOUT FEES:

I charge a sliding-scale fee for my work as your attorney in the name change process. The full rate is $1,000 for adults, and $1,500 for minors. If you cannot afford the full rate, then just pick the option below for how much you can afford to pay for my services. This sliding-scale fee operates on the HONOR SYSTEM -- I will not ask for proof of your financial situation, but in return I ask that you honestly respond with how much you can actually afford to pay for these services. I am able to offer discounted services for some folks because others pay more when they can.

Please note: the sliding-scale fee ONLY covers my work as your attorney. You may also be responsible to pay:
* $210 filing fee (we can try to get this waived by the court if you are financially eligible)
* Publication of your name change in a local newspaper (if required, though we can try to get this waived, too)
* At least 1 certified copy of your order ($5-10 each)

Thank you, and I look forward to connecting with you soon!

Milo Primeaux, Esq.
Pronouns: he, him, his
P.O. Box 665, Dansville, NY 14437-0665
(585) 612-1071 | MiloPrimeauxEsq@gmail.com
https://miloprimeaux.com

Email address *
New/Preferred Name *
The name you go by and that you hope to become your new legal name.
Your answer
Birth/Given Name *
The name you were assigned at birth.
Your answer
Name to Use on Mailed Letters *
For safety purposes, please tell me which name you want me to use on envelopes if I send you something in the mail.
Your answer
Pronouns (if any) *
How do you like to be addressed? For example, she/her/hers, he/him/his, they/them/their, etc.
Your answer
Date of Birth *
The name change process is different for adults and minors.
MM
/
DD
/
YYYY
City, State of Birth (and Country, if not U.S.) *
Your answer
Do you have access to your birth certificate? *
Required
Minors Only: Name of Parents / Legal Guardians
ONLY answer this if you are currently a minor (17 years old or younger). We may need to involve your parents/legal guardians in the process -- if they are not supportive of your name change, we can discuss your options.
Your answer
Phone Number *
Your answer
Residential Address *
Your full residential address, including Apt # if applicable. You cannot use a PO Box for your residential address.
Your answer
Mailing Address (if different from above)
If same as your residential address, you can skip this question. Please include PO Box or Apt #, if applicable.
Your answer
County of Residence *
List the county where you have your permanent legal residence. If you are a student and are not sure which county to put down, please provide both below.
Your answer
Do you owe spousal support? *
By law, you must disclose whether you owe spousal support obligations. If you are behind on spousal support payments, please provide some details about below under 'Other'.
Required
Do you owe any child support? *
By law, you must disclose whether you owe child support obligations. If you are behind on child support payments, please provide some details about it below under 'Other'.
Required
Do you have any judgments or liens against you? *
By law, you must disclose if a court has issued a judgment against you for a debt you owe to a creditor, and/or if there are liens on your property (vehicles, home, wages/paychecks, etc.). If you don't know, choose 'Not Sure'.
Required
Have you ever filed for or adjudicated a bankruptcy? *
By law, you must disclose this information.
Required
Do you have any criminal convictions on your record? *
By law, you must disclose misdemeanor and felony convictions on your name change petition. Mere violations do not need to be disclosed.
Required
Are you involved in any pending or open court cases (criminal or civil) or other administrative proceedings? *
Required
Have you ever tried to legally change your name before? *
If the answer is 'Yes', please give more information under 'Other' about your previous name change -- when it happened, what court, what was the new name, and why it was denied (if applicable).
Required
Language Access Needs or Reasonable Accommodations?
I will do everything I can to make reasonable accommodations for you so that we can communicate effectively.
Your answer
Interested in Discounted Sliding-Scale Fee? *
My sliding-scale fee operates on an HONOR SYSTEM -- I will not ask for proof of your financial situation, but in return I ask that you honestly respond with how much you can actually afford to pay for these services. I can afford to offer discounted services for some folks because others pay more when they can.
How did you hear about my services?
Your answer
A copy of your responses will be emailed to the address you provided.
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