Name Change Form

This form can only be submitted after a judge has completed and signed your name change documents. All information that is submitted on this form needs to exactly match your court documents. The Daily Record will not be held liable for mistakes or misprints based on the information submitted in this form.

Once this form has been submitted, your notice will take about 2-3 business days to appear in the Rochester Daily Record. Once your notice has appeared in the paper, your Affidavit of Publication will be sent to you by mail to address listed on this form.

Please note, in order to limit the amount of people in our offices, affidavits are currently being mailed out on a weekly basis.

This form cannot be submitted without payment. The fee to submit a name change is $40.

Please email [email protected] or call 585-232-6920 and press option 3 if you have any questions about submitting a name change.

Name Change

To submit a name change, please fill in the information below and upload any associated court documents.

Name Change Information:
Current/Old Name*
First Middle Last
You must include all parts of your name including middle name. Please capitalize your name where appropriate. For example: Your name would show as Jon Jacob Smith not jon jacob smith.
New Name*
First Middle Last
You must include all parts of your name including middle name. For example: Jon Jacob Smith would change to Justin Jacob Smith.
Date the papers were filed/ day the judge signed the paper*
Month
Day
Year
Index Number*
City & State of present address*
City State / Province / Region
Month & Year of birth*
City & State (or country) of birth*
City State/Country
Please Attach Court Files
Max. file size: 73 MB.
Contact Information:
Please provide accurate and up-to-date contact information. This information will only be used to contact you about your name change submission and to send you your affidavit via mail.
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Product Name
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
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Name Change Form

Name Change

Name Change Information:

Contact Information:

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