15 V.S.A. § 811: Procedure; form

A person of age and sound mind may change his or her name by making, signing, sealing, and acknowledging before the judge of the Probate Division of the Superior Court of the district in which the person resides, an instrument in the following form:

STATE OF VERMONT

____________ District. }

____________ District. }

Be it remembered, that I, A. B. of __________ in the county of _________ , will be hereafter known and called ______________ .

In witness whereof I hereunto set my hand and seal this ______ day of ______ , 20 ____ .

A. B. (L. S.)