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NICK, JR., DISTRICT ATTORNEY PETITION FOR NAME CHANGE I. Petitioner, , born on , , with social security number , and domiciled in Jefferson Parish, Louisiana, wants to change his (her) name to for the following reason(s): II. State reason(s) for name change here. III. This proceeding is brought under LSA R.S. 13:14751-13:4755, an.

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