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STATE OF MICHIGAN
3rd JUDICIAL CIRCUIT - FAMILY DIVISION
WAYNE COUNTY
Court address
CASE NO. and JUDGE
PETITION TO CHANGE NAME
Coleman
A. Young Municipal Center, 2 Woodward Avenue
Detroit, MI 48226
Court telephone no.
(313) 224-5261
Note: This petition must be accompanied by a notice of hearing prepared for publication under MCR 3.613 (see PC 50). Every
person 22 years of age or older who is requesting a name change must have a criminal background check. For details, go to
michiganlegalhelp.org.
In the matter of DAVID GABRIEL KITTRELL
Present first, middle, and last name(s) (type or print)
Petitioner’s name, address, and telephone no.
Petitioner’s attorney, bar no., address, and telephone no.
DAVID GABRIEL KITTRELL
9044 Bryden
Detroit , MI 48204
(810) 892-3301
1. An action within the jurisdiction of the family division of circuit court involving the family or family members of
person(s) named above has/have been previously filed in
Case Number
and remains Court,
, was assigned to Judge
is no longer pending.
,
2. The name change is for
a. a married person who wishes to also include a name change for his/her
spouse.
minor child(ren), of whom the petitioner has legal custody. (For a minor 14 years or older, written consent is required. See
form PC 51b.)
X b. an adult.
c. a minor, whose natural or adopted parents are
Parent
and
Parent
Both parents are deceased. The guardian is
(Attach letters of guardianship.)
Deceased
Deceased
.
Name
.
3. The name change is for the following reason: Religious conformity, practice/ freedom of religion
4. The name change is not sought for any fraudulent intent.
5. The following person(s) seeking a name change has/have a criminal record:
6. Each person for whom a name change is sought has been a resident of the county for at least one year.
Approved, SCAO
Form PC 51, Rev. 4/21
MCL 333.2872, MCL 711.1, MCR 3.613
Page 1 of 3
SRL
Petition to Change Name (4/21)
Page 2 of 3
Case No.
Note: Skip item 7 if the noncustodial parent consents to the name change or if there is not a noncustodial parent.
7. I have legal custody of the minor.
a. The noncustodial parent has had the ability to visit, contact, or communicate with the child and has regularly and
substantially failed or neglected to do so for a period of two years or more before the filing of this petition and
either:
a support order has been entered, and the noncustodial parent has failed to substantially comply with the
order for a period of two years or more before the filing of this petition; or
a support order has not been entered and the noncustodial parent, having the ability to support or assist in supporting the child, has failed or neglected to provide regular and substantial support for two years or more
before the filing of this petition.
b. The noncustodial parent has been convicted of child abuse (MCL 750.136b), criminal sexual conduct (MCL 750.520b,
750.520c, 750.520d, or 750.520e), or assault with intent to commit criminal sexual conduct (MCL 750.520g) and the child
or a sibling of the child was the victim. (Attach judgment of sentence.)
c. The noncustodial parent has been convicted of first degree murder (MCL 750.316) or second degree murder
(MCL 750.317). (Attach judgment of sentence.)
d. The last known address of the noncustodial parent is:
.
The noncustodial parent is not living at the above address, and I have taken the following steps to locate him/her:
8. I request the following name change(s):
Petitioner
FROM
DAVID GABRIEL KITTRELL
(Type or print first name, middle name, and last name.)
TO
JEHOHYAH HOH EL
Spouse
DATE OF BIRTH
Put DOB in Ref. No. row 10 on MC 97a.
Put DOB in Ref. No. row 11 on MC 97a.
Minor child
Put DOB in Ref. No. row 12 on MC 97a.
Minor child
Put DOB in Ref. No. row 13 on MC 97a.
Minor child
Put DOB in Ref. No. row 14 on MC 97a.
Minor child
Put DOB in Ref. No. row 15 on MC 97a.
Minor child
Put DOB in Ref. No. row 16 on MC 97a.
If you want a new live birth certificate, check item 9. A special order is not needed if you only want to add the changed name(s) to the original certificate(s).
9. I request the court to order the State Registrar to create a new live birth certificate that does not disclose the name of
N/A
at birth and to seal the original certificate.
Name
I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best
of my information, knowledge, and belief.
Date
Petitioner signature
Petition to Change Name (4/21)
Page 3 of 3
Case No.
SIGNATURE OF PARENT/GUARDIAN FOR MINOR
Date
Date
Signature
Signature
Name (type or print)
DAVID GABRIEL KITTRELL
9044 Bryden
Name (type or print)
Address
Address
Detroit , MI 48204
City, state, zip
CONSENT BY SPOUSE OF PETITIONER
(810) 892-3301
Telephone no.
City, state, zip
Telephone no.
If the petition is filed for a spouse, this consent must be signed by the spouse of the petitioner.
I am the spouse of the petitioner and consent to the granting of this petition to change my name.
Date
Signature
Address
Name (type or print)
City, state, zip
Attorney signature
Address
Attorney name (type or print)
Bar no.
City, state, zip
Telephone no.
Telephone no.
JIS Code: API
STATE OF MICHIGAN
JUDICIAL DISTRICT
3rd JUDICIAL CIRCUIT
COUNTY PROBATE
CASE NO. and JUDGE
ADDENDUM TO
PROTECTED PERSONAL
IDENTIFYING INFORMATION
Court address
Coleman A. Young Municipal Center, 2 Woodward Avenue
Detroit, MI 48226
Plaintiff’s/Petitioner’s name
Court telephone no.
(313) 224-5261
v
DAVID GABRIEL KITTRELL
Defendant’s/Respondent’s name
In the matter of DAVID GABRIEL KITTRELL
If this form is filed on or after January 1, 2022, it will be maintained as a nonpublic document because the form
contains personal identifying information (PII) that will be protected when amendments to MCR 1.109 become effective
on January 1, 2022. Use this form to provide PII only for a person who is a NOT a defendant, respondent, or decedent. If
the person is a defendant, respondent, or decedent use form MC 97.
Instructions:
• Use this form when an SCAO-approved form instructs you to use it to provide PII. • Provide only the PII required for your particular case. For example, if you are filing a document that requires you to
provide a date of birth to the court, complete only that field on this form.
Name of form/document that this MC 97a is being filed with: Petition to Change Name
DAVID GABRIEL KITTRELL
01/31/2022
Printed name of individual completing form and date
Ref.
No.
10
11
12
13
14
15
16
17
18
Instructions: Provide the name of the person that the PII applies to, followed by the specific PII that is required. For Other, specify the type of
PII in addition to the PII itself ‑ for example, Social Security No. XXXX. Use the below reference number (Ref. No.) in the document being filed in
place of the PII. For example, insert “Ref. No. XX” in place of the DOB in the document.
Name
DOB
Other
DAVID GABRIEL KITTRELL
Name
June 17, 1983
DOB
Other
Name
DOB
Other
Name
DOB
Other
Name
DOB
Other
Name
DOB
Other
Name
DOB
Other
Name
DOB
Other
Name
DOB
Other
Approved, SCAO
Form MC 97a, Rev. 7/21
Page 1 of 1
SRL
JIS Code: OCN
STATE OF MICHIGAN
3rd JUDICIAL CIRCUIT - FAMILY DIVISION
WAYNE COUNTY
ORDER FOLLOWING HEARING ON
PETITION TO CHANGE NAME
(Part 1)
CASE NO. and JUDGE
Court address Coleman
A. Young Municipal Center, 2 Woodward Avenue
Detroit, MI 48226
Court telephone no.
(313) 224-5261
In the matter of DAVID GABRIEL KITTRELL
Present first, middle, and last name(s) (type or print)
THE COURT FINDS:
1. A petition for name change has been filed.
2. Notice of hearing was given by publication.
3. Each person for whom a name change is sought has been a resident of the county for at least one year.
4. The court has received the required criminal record report(s) from the Michigan Department of State Police.
5.
has a criminal record.
Name (type or print)
6. The request for the name change of DAVID GABRIEL KITTRELL
Name (type or print)
is is not made with fraudulent intent.
7. The petitioner, having legal custody, requests the name change of a minor. The noncustodial parent has consented to
the name change.
8. The petitioner requests the name change of a minor. The custodial parent has consented to the name change. The
noncustodial parent was given notice of the hearing.
a. The noncustodial parent has had the ability to visit, contact, or communicate with the minor but has regularly and
substantially failed or neglected to do so for the past two years, and
a support order has been entered, and the noncustodial parent has failed to substantially comply with the
order for a period of two years or more before the filing of the petition for name change.
or
a support order has not been entered and the noncustodial parent, having the ability to support or assist supporting the child, has failed or neglected to provide regular and substantial support for two years or more
before the filing of the petition for name change.
b. The noncustodial parent has been convicted of child abuse (MCL 750.136b), criminal sexual conduct (MCL 750.520b,
or assault with intent to commit criminal sexual conduct (MCL 750.520g), and the child
or a sibling of the child was the victim.
750.520c, 750.520d, or 750.520e),
9. The minor(s) 14 years of age or older signed a written consent to change name in the presence of the court.
10. The minor(s) under the age of 14 has/have stated a preference to a name change.
11. The minor(s) is/are not of sufficient age to express a preference to a name change.
Approved, SCAO
Form PC 52, Rev. 1/21
MCL 333.2872, MCL 711.1, MCR 3.613
Page 1 of 2
SRL
Distribute form to:
Court, Part 2
Petitioner, Part 1
Law enforcement, Part 1 (as needed)
Department of Corrections, Part 1 (as needed)
Order Following Hearing on Petition to Change Name (1/21)
Page 2 of 2
Case No.
12. The name(s) of the following person(s) is/are changed.
Petitioner
FROM
TO
JEHOHYAH HOH EL
DAVID GABRIEL KITTRELL
DATE OF BIRTH
month, day, year
06/17/1983
Spouse
month, day, year
Minor child
month, day, year
Minor child
month, day, year
Minor child
month, day, year
Minor child
month, day, year
13. The State Registrar shall create a new live birth certificate for N/A
Name
that does not disclose the name at birth and shall seal the original certificate.
14. The request to change the name of
is denied.
Name
15. The request is denied and the petition is dismissed.
Attorney Name (type or print)
Judge signature and date
Bar no.
Address
City, state, zip
Telephone no.
Note to Petitioner: You must provide this order to the State Registrar if you want to change your birth certificate.
Note to Clerk: Under MCL 711.1(3), if the court enters an order to change the name of a person who has a criminal record,
the court shall forward the order to the Criminal Justice Information Center of the Michigan State Police and to one or more
of the following:
• The Department of Corrections if the person named in the order is in prison or on parole or has been imprisoned or
released from parole in the immediately preceding two years.
• The sheriff of the county in which the person named in the order was last convicted if the person was incarcerated in a
county jail or released from a county jail within the immediately preceding two years.
• The court that has jurisdiction over the person named in the order if the person named in the order is under the jurisdiction
of the family division of the circuit court.
JIS Code: OCN
STATE OF MICHIGAN
3rd JUDICIAL CIRCUIT - FAMILY DIVISION
WAYNE COUNTY
Court address
ORDER FOLLOWING HEARING ON
PETITION TO CHANGE NAME
(Part 2)
CASE NO. and JUDGE
Coleman
A. Young Municipal Center, 2 Woodward Avenue
Detroit, MI 48226
Court telephone no.
(313) 224-5261
In the matter of DAVID GABRIEL KITTRELL
Present first, middle, and last name(s) (type or print)
THE COURT FINDS:
1. A petition for name change has been filed.
2. Notice of hearing was given by publication.
3. Each person for whom a name change is sought has been a resident of the county for at least one year.
4. The court has received the required criminal record report(s) from the Michigan Department of State Police.
5.
has a criminal record.
Name (type or print)
6. The request for the name change of DAVID GABRIEL KITTRELL
Name (type or print)
is is not made with fraudulent intent.
7. The petitioner, having legal custody, requests the name change of a minor. The noncustodial parent has consented to
the name change.
8. The petitioner requests the name change of a minor. The custodial parent has consented to the name change. The
noncustodial parent was given notice of the hearing.
a. The noncustodial parent has had the ability to visit, contact, or communicate with the minor but has regularly and
substantially failed or neglected to do so for the past two years, and
a support order has been entered, and the noncustodial parent has failed to substantially comply with the
order for a period of two years or more before the filing of the petition for name change.
or
a support order has not been entered and the noncustodial parent, having the ability to support or assist supporting the child, has failed or neglected to provide regular and substantial support for two years or more
before the filing of the petition for name change.
b. The noncustodial parent has been convicted of child abuse (MCL 750.136b), criminal sexual conduct (MCL 750.520b,
or assault with intent to commit criminal sexual conduct (MCL 750.520g), and the child
or a sibling of the child was the victim.
750.520c, 750.520d, or 750.520e),
9. The minor(s) 14 years of age or older signed a written consent to change name in the presence of the court.
10. The minor(s) under the age of 14 has/have stated a preference to a name change.
11. The minor(s) is/are not of sufficient age to express a preference to a name change.
Approved, SCAO
Form PC 52, Rev. 1/21
MCL 333.2872, MCL 711.1, MCR 3.613
Page 1 of 2
SRL
Distribute form to:
Court, Part 2
Petitioner, Part 1
Law enforcement, Part 1 (as needed)
Department of Corrections, Part 1 (as needed)
Order Following Hearing on Petition to Change Name (1/21)
Page 2 of 2
Case No.
12. The name(s) of the following person(s) is/are changed.
Petitioner
FROM
TO
DATE OF BIRTH
month, day, year
JEHOHYAH HOH EL
DAVID GABRIEL KITTRELL
Spouse
month, day, year
Minor child
month, day, year
Minor child
month, day, year
Minor child
month, day, year
Minor child
month, day, year
13. The State Registrar shall create a new live birth certificate for N/A
Name
that does not disclose the name at birth and shall seal the original certificate.
14. The request to change the name of
is denied.
Name
15. The request is denied and the petition is dismissed.
Attorney Name (type or print)
Judge signature and date
Bar no.
Address
City, state, zip
Telephone no.
Note to Petitioner: You must provide this order to the State Registrar if you want to change your birth certificate.
Note to Clerk: Under MCL 711.1(3), if the court enters an order to change the name of a person who has a criminal record,
the court shall forward the order to the Criminal Justice Information Center of the Michigan State Police and to one or more
of the following:
• The Department of Corrections if the person named in the order is in prison or on parole or has been imprisoned or
released from parole in the immediately preceding two years.
• The sheriff of the county in which the person named in the order was last convicted if the person was incarcerated in a
county jail or released from a county jail within the immediately preceding two years.
• The court that has jurisdiction over the person named in the order if the person named in the order is under the jurisdiction
of the family division of the circuit court.
STATE OF MICHIGAN
CASE NO. and JUDGE
JUDICIAL CIRCUIT - FAMILY DIVISION
PUBLICATION OF NOTICE OF
HEARING FOR NAME CHANGE
WAYNE COUNTY
Court address
Coleman A. Young Municipal Center, 2 Woodward Avenue
Detroit, MI 48226
Court telephone no.
(313) 224-5261
In the matter of the name change of DAVID GABRIEL KITTRELL
Current name of the subject of the petition
TO ALL PERSONS, including: (specify non-custodial parent’s name here, if applicable)
whose address is unknown and whose interest in the matter may be barred or affected by the following:
TAKE NOTICE: A hearing will be held on
at
Date and time
Location
before Judge
to change the name of:
DAVID GABRIEL KITTRELL
to JEHOHYAH HOH EL
Current name
Proposed name
to
Current name
to
Current name
to
Current name
to
Current name
to
Current name
Proposed name
Proposed name
Proposed name
Proposed name
Proposed name
PUBLISH ABOVE INFORMATION ONLY
Publish
time(s) in
Furnish
copies to
Name of publication
in
County.
.
Furnish affidavit of publication to the court. Petitioner shall file affidavit of publication with the court clerk.
Forward statement for publication charges to
Approved, SCAO
Form PC 50, Rev. 7/21
MCL 711.1, MCR 2.106(D), MCR 3.613
Page 1 of 1
SRL
.
Checklist- How to ask for a name change
These are step-by-step instructions to help you ask a judge to change your name. It is best to read all the
steps before starting. Keep a copy of everything you file for your records.
Step 1: Complete the forms.
You have completed the forms using our Do-It-Yourself Name Change. You will not file all of these forms
at the beginning of your case. You will file some later.
Sign the Petition for Name Change as the petitioner.
Step 2: File the petition and pay the fees.
File the completed Petition for Name Change at the circuit court in the county where you live.
You will have to pay the filing fee of $175 when you file the petition. If you cannot afford this, you may
qualify for a fee waiver for the filing fees only. Return to Michigan Legal Help and read the Fee Waivers
in Court Cases article to get more information about fee waivers. You can also use the Do-It-Yourself
Fee Waiver to complete the form.
Step 3: Get a criminal background check.
If you are 22 years old or older, you must have a criminal background check done.
First, get fingerprinted at a local police agency. The cost to get fingerprinted will vary depending on the
agency. Check with your local agency about the cost. Then mail your fingerprints, a copy of your Petition
to Change Name, and check or money order for $42 (made out to the State of Michigan) to:
Michigan State Police, CJIC
Identification Section
P.O. Box 30266
Lansing, Michigan 48909
This fee amount and address were listed on the Michigan State Police Department website as of January
2017. It is always a good idea to confirm the fee and address before sending your information and
payment. To confirm the address and more information about the process, go to the Michigan State
Police Department website at www.michigan.gov/msp.
The state police will forward a second copy of your fingerprints to the Federal Bureau of Investigations
(FBI). It usually takes three to five weeks to complete the background check.
The state police department will report its findings and any information it got from the FBI to the court
where you filed your petition. The court will not schedule a hearing for your name change until it gets
the report from the state police. If you have no pending charges or criminal record, the state police will
destroy its copy of your fingerprints.
Step 4: Schedule a hearing.
After the court receives the report from the state police, a hearing will be scheduled. Some courts
require you to call and schedule it. Other courts will schedule it for you and send you a Notice of
Hearing. You can ask the court clerk about scheduling your hearing when you file your petition.
Step 5: Publish your Notice of Hearing.
All notices of name change hearings must be published in a local newspaper. This gives people your
name change may affect a chance to object to it. The Publication of Notice of Hearing Form is one of the
forms you got at the end of the Do-It-Yourself Name Change. There is typically a fee for publication. A
fee waiver from the court will not waive the publication fee.
Some courts work with the local Legal News for publication. These courts will send a copy of the
Publication of Notice of Hearing form to the Legal News when you file the form. The Legal News will bill
you for $80.25. After you pay the fee, the Legal News will mail you the original Affidavit of Publication
for you to file with the court.
Other courts require you to contact a local newspaper to publish your notice. You may need to ask the
newspaper to publish your notice right away. The cost will vary depending on the newspaper.
After the local newspaper publishes your name change notice, submit a copy of the published notice
and Affidavit of Publication to the court. The newspaper must complete the Affidavit of Publication, not
you. The Affidavit of Publication must list the qualifications of newspaper and the date or dates the
notice was published.
Most newspapers have a standard affidavit form they use. If the newspaper publishing your notice does
not, you can use this standard Affidavit of Publication Form.
The judge will not sign the order granting your name change without the published notice and the
Affidavit of Publication.
The notice must be published before your name change hearing. Depending on the county you live in,
the notice needs to be published between two and eight weeks before the hearing. Some courts require
you to check with them three days before your hearing to make sure they got the publication
information. You can contact your local circuit court to find out its publication requirements. Use the
Court Information section of Michigan Legal Help to get contact information for your local circuit court.
If you have a good reason you don’t want to publish the notice, you can ask the judge to keep the record
of the proceedings confidential. The judge will only do this if publishing the notice would put you in
physical danger. If the judge orders the case be kept confidential, you don’t have to publish anything
about your name change.
Step 6: Attend the Hearing.
On the day of your hearing, bring any documents related to your name change. It is always a good idea
to have two copies of the documents, so you can give one to the judge.
At the hearing, the judge will likely ask you questions about the information in your petition. The judge
will also give anyone who objects to your name change a chance to talk about their reasons for
objecting.
If the judge approves the petition, the judge will complete and sign the order changing your name. The
order is one of the documents you got from the Do-It-Yourself Name Change.
There is a $10.00 fee to have the court enter the order. If you were granted a fee waiver, this fee will be
waived.
If you want a certified copy of the order, it costs another $10.00. This may not be covered by a fee
waiver.
Step 7: Contact any agency that has your old name.
After a name change, other records that use your old name will not change automatically. Contact any
agency or organization that normally deals with you under your old name to tell them about the change.