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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, please check your email regularly for a proof of your printed name change. Once you receive a proof of your printed name change, please review the proof and inform us of any mistakes by the deadline specified in the email. If we are not notified of any changes by the specified deadline, the proof will be sent to print as is.

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

Please contact Alys Derby if you have any questions about submitting a name change.
aderby@bridgetowermedia.com
585-653-4018

Name Change Form

To submit a name change, please fill in the information below and upload any associated court documents.
  • Name Change Information:

  • 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.
  • You must include all parts of your name including middle name. For example: Jon Jacob Smith would change to Justin Jacob Smith.
  • 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.
  • $0.00
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