New Jersey Form CN-12164 is the Certification of Confidential Information for Name Change, the sealed sheet where a name-change applicant lists private data like a Social Security number so the court can verify identity without exposing it in the public file. It is filed with the Superior Court of New Jersey as part of every adult and minor name change packet, and it travels with the public Verified Complaint as its protected twin.
This little one-page form carries weight far beyond its size. New Jersey courts process thousands of name change applications each year, and a single mismatched digit on this confidential sheet can stall a case for weeks, because the Division of Criminal Justice cross-checks your data against criminal and identity records before a judge signs off.
Here is what you will walk away knowing:
- 🧾 What each field on Form CN-12164 asks and exactly how to fill it in
- 🔒 Why the form stays sealed and what happens if private data leaks into the public record
- 👨👩👧 How adults and parents of minors complete different versions of the same form
- 📬 Every way to file it, the fees attached to the larger case, and the deadlines that follow
- ⚠️ The field-level mistakes that delay name changes and how to dodge each one
What the Form Is and Who Must File It
Form CN-12164 is the Certification of Confidential Information for Name Change. It appears inside the New Jersey Judiciary name change packets as Form A1 for adults and Form F1 for minors, and both versions were last revised on June 11, 2021. Confirm that revision date in the footer before you start so you know you have the current version, since the courts update these forms as statutes and rules change.
The form exists because of a privacy problem. Your Verified Complaint becomes part of a public court file, yet the court still needs your Social Security number and home address to confirm you are who you say you are. The Certification of Confidential Information solves this by holding that sensitive data on a separate sheet that the court keeps out of public view, which protects you from identity theft while still giving the judge what they need.
Anyone filing a name change in New Jersey must complete it. Adults filing in the Civil Division use the Adults Only packet, CN 10551, while parents changing a child’s name file in the Chancery Division, Family Part using packet CN 10552. A separate Form CN-12164 must be submitted for each person whose name is changing, and each person receives their own docket number.
The whole process rests on N.J.S.A. 2A:52-1 to -4, the statute that lets a New Jersey resident assume a new name through the Superior Court. Ignoring the confidential certification means the court cannot verify your identity, and your application will not move forward. A common misconception is that this form is optional paperwork; it is not, and the packet checklist treats the original as a required filing alongside the complaint.
Before You Start: Documents and Information You Need
Gather everything below before you open the form. Missing one item is the difference between a smooth filing and a returned packet, and the court will not chase you for what you forgot.
- Your full current legal name as it reads on your Social Security card, because the court matches this against federal records and a mismatch triggers a verification hold.
- The exact new name you want to assume, spelled and capitalized the way it will appear forever, since a typo here can carry into the Final Judgment.
- Your Social Security number, the heart of this form, because the court and Division of Criminal Justice use it to confirm identity and screen for fraud.
- Your current residential street address, not a P.O. Box, because the form asks where you actually reside and venue depends on your county.
- The minor child’s Social Security number if you are filing Form F1, because the child’s identity must be verified just like an adult’s.
- Your county of residence, which sets the court where you file and appears in the case caption.
- A working email address and phone number for the caption, because the court uses these to return docketed copies and reach you about the hearing.
- The $250 filing fee in check or money order payable to Treasurer, State of New Jersey, because the packet will not be processed without it, even though CN-12164 itself carries no separate charge.
Take Maria Lopez, an adult in Bergen County. Before she touched the form she pulled her Social Security card, confirmed her address, and set aside the $250 fee, so when she opened Form A1 she filled it in once and never had to stop. Skipping this step is the top reason self-filers mail incomplete packets that bounce back.
Where to Get the Form and How to Access It
You get Form CN-12164 directly from the New Jersey Judiciary, free of charge. Adults download the Civil Division packet CN 10551, and parents of minors download the Family Part packet CN 10552, which contains Form A1 for adults and Form F1 for minors as fillable PDFs. The form lives inside the packet rather than as a standalone download, so grab the whole packet.
Each form must be typed or printed clearly on 8½” x 11” white paper only. Forms filed on a different size or color of paper will be rejected, so do not use legal-size sheets or colored stock. The PDF is fillable on a computer, which cuts down on handwriting errors that slow processing.
You can also pick up the packet at any county courthouse customer counter if you prefer paper. The official source is always the NJ Courts forms library or the county courthouse, and if a download link gives you trouble, right-click the link and choose “Save link as” to save the PDF locally. Avoid third-party sites that may host outdated versions; the revision date in the footer should read June 11, 2021.
Step-by-Step: How to Fill Out Form CN-12164 Line by Line
Form CN-12164 is short, but every blank matters because it is sworn under penalty. Work through the caption first, then the numbered statements, then the signature block. Below, each field gets its own walkthrough.
The Case Caption: Name, Address, Email, Telephone
The top-left block asks for your name, street address, city, state, ZIP, email address, and telephone number. This is the contact header the court uses to identify and reach you. Type your information into each labeled line.
To answer it, enter your current legal name on the Name line, your full street address split across the address and city/state/zip lines, then your email and phone. For example, Maria Lopez writes Maria Lopez, then 412 Oak Avenue, then Hackensack, NJ 07601, then mlopez@email.com and 201-555-0147. Use the name you hold now, not the one you want, because you have not legally changed it yet.
A nuance comes up if you have no email; leave it blank rather than inventing one, since the court can still reach you by mail and phone. A common mistake is entering the new name in this caption, which confuses the clerk about who is filing and can delay docketing. The misconception here is that the caption is just decoration; it is actually how the court links this sealed form to your public complaint.
The “County” and “Docket No.” Lines
The caption also contains a County line and a Docket No. line. The County line names the New Jersey county where you file, and the Docket No. line is left blank because the court assigns it later. These two fields connect your form to the correct courthouse and case.
Fill in only the county. For instance, Maria writes Bergen on the County line and leaves Docket No. empty. The form itself prints “(To be filled in by the court)” beside the docket box, which is your cue to stop.
The edge case is filing in the wrong county; you must file where you reside, so a Newark resident uses Essex, not wherever is convenient. A frequent mistake is writing your own guessed docket number in the blank, which can create filing confusion and force the clerk to re-key the case. The misconception is that you need a docket number to file; you do not, because the court creates it when it receives your packet and writes it on the copies it returns to you.
The “In the Matter of the Application of” Block
This block restates who is applying and what name they want to assume. For adults it shows “Your Name” and “To Assume the Name of.” For minors on Form F1 it shows your name, the child’s current name, and the name the child will assume. It mirrors the heading on your Verified Complaint so the two forms match.
Enter your current name in the first slot and the target name in the second. Maria writes Maria Lopez and then Maria Lourdes Vega. A parent, say David Chen, filing for his son writes David Chen, then Liam Chen, then Liam David Chen-Park.
The edge case is a multi-part new name; write every part exactly as you want it recorded, including any hyphen. A mistake here is letting this block disagree with the Verified Complaint, which signals an inconsistency the court may flag. The misconception is that small spelling differences will be “fixed” by the court; they will not, because the judge orders the name precisely as written.
Statement 1: Plaintiff Identity and Residence
The opening certified statement reads that you are the Plaintiff and currently reside at a given street address, in a named city and county, in the State of New Jersey. This anchors your identity and proves New Jersey residency, which the statute requires. The blanks are your street address, city, and county.
Fill each blank with your real, current residence. Maria writes that she resides at 412 Oak Avenue, in the City of Hackensack, County of Bergen. The address must match the caption so the record stays consistent.
If you have a P.O. Box, you still must list a physical street address here, because residency is about where you live, not where you collect mail. A common mistake is listing an old address after a recent move, which can misroute hearing notices and undermine venue. The misconception is that any New Jersey address works; it does not, because you generally file in the county where you actually reside.
Statement 2: Social Security Number (Adult Form A1)
This is the core field. On the adult form it reads “My social security number is,” followed by a blank. The entire reason this sheet stays sealed is to protect this number, which the court uses to verify identity and run a background screen.
Write your nine-digit Social Security number in the standard format. Maria enters 123-45-6789. Double-check every digit against your physical Social Security card rather than typing it from memory.
The edge case is having no Social Security number; if that is your situation, contact the Family Division before filing, because the court needs an alternative way to verify you. A single wrong digit is the most damaging mistake on this entire form, because it causes the identity cross-check to fail and freezes your case until corrected. The misconception is that you can leave this blank “for privacy”; you cannot, because the sealed certification is precisely the mechanism that keeps it private while still satisfying the court.
Statement 2: Child’s Social Security Number (Minor Form F1)
On the minor version, the same statement reads “My child’s social security number is,” followed by a blank. The parent or guardian supplies the child’s number so the court can verify the minor’s identity in the sealed file. Everything else about the field works like the adult version.
Enter the child’s nine-digit number exactly as printed on the child’s Social Security card. David Chen writes 987-65-4321 for his son Liam. Pull the child’s card; do not guess.
The edge case is a newborn or recent immigrant without a number yet; raise this with the Family Division before filing rather than leaving it blank. The common mistake is transposing the child’s and parent’s numbers, which corrupts the verification for both. The misconception is that a minor does not need a Social Security number on file; the court treats the child’s identity verification with the same seriousness as an adult’s.
The Certification and Signature Block
The closing block states: “I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment.” Below it sits a Dated line and a Signature of Plaintiff line. This is your sworn oath that everything above is accurate.
Sign your current legal name and write the date you sign. Maria signs Maria Lopez and dates it 07/15/2026. The fillable PDF shows an “s/” before the signature line, which is the e-signature convention if you submit electronically.
The edge case is a parent signing for a minor; the parent signs in their own current name as Plaintiff, not the child’s name, because the parent is the one certifying. The serious mistake is signing the new name you have not yet been granted, which makes the certification false on its face. The misconception is that this signature is a formality; it is a sworn statement, and a willfully false entry exposes you to punishment under the certification language.
Three Filled-Out Examples Using Real Scenarios
Below are three common fact patterns, each following one named filer through Form CN-12164 from caption to signature.
Scenario 1 — Maria Lopez, adult changing her name for personal reasons (Form A1)
| Form Section | What Maria Enters |
|---|---|
| Name (caption) | Maria Lopez |
| Street address | 412 Oak Avenue |
| City, State, Zip | Hackensack, NJ 07601 |
| County | Bergen |
| Docket No. | Left blank for the court |
| To Assume the Name of | Maria Lourdes Vega |
| Statement 1 residence | 412 Oak Avenue, Hackensack, Bergen |
| Statement 2 SSN | 123-45-6789 |
| Dated / Signature | 07/15/2026 / Maria Lopez |
Scenario 2 — Aisha Rahman, transgender adult updating to an affirmed name (Form A1)
| Form Section | What Aisha Enters |
|---|---|
| Name (caption) | Aisha Rahman |
| Street address | 88 Grove Street, Apt 3B |
| City, State, Zip | Jersey City, NJ 07302 |
| County | Hudson |
| Docket No. | Left blank for the court |
| To Assume the Name of | Aisha Noor Rahman |
| Statement 1 residence | 88 Grove Street, Apt 3B, Jersey City, Hudson |
| Statement 2 SSN | 222-33-4455 |
| Dated / Signature | 08/02/2026 / Aisha Rahman |
Scenario 3 — David Chen, parent changing his minor son’s name (Form F1)
| Form Section | What David Enters |
|---|---|
| Name (caption) | David Chen |
| Street address | 27 Maple Drive |
| City, State, Zip | Princeton, NJ 08540 |
| County | Mercer |
| To Change the Name of | Liam Chen |
| To (new name) | Liam David Chen-Park |
| Statement 1 residence | 27 Maple Drive, Princeton, Mercer |
| Statement 2 child’s SSN | 987-65-4321 |
| Dated / Signature | 09/10/2026 / David Chen |
Notice that in every case the signer uses their current legal name, the new name appears only in the “to assume” slot, and the Social Security number is copied straight from the card. Marcus, another adult filer in Camden County, followed this same pattern and had his packet docketed without a single follow-up request.
How to File the Completed Form
You never file Form CN-12164 by itself. It goes in as the original alongside the Verified Complaint, Order Fixing Date of Hearing, Final Judgment, and Final Judgment Addendum, plus the $250 fee. New Jersey gives you three filing channels.
- Online (JEDS). Submit through the Judiciary Electronic Document Submission portal. You upload the completed forms, pay electronically, and receive an electronic confirmation, which is your proof of filing. Processing follows the order documents are received.
- By mail. Send the original plus one copy of every form, the $250 check or money order payable to Treasurer, State of New Jersey, and a self-addressed stamped envelope to the Family or Civil Division of your county courthouse, with the address listed at njcourts.gov. Use certified mail, return receipt requested, and keep the green receipt as proof.
- In person (delivery). Hand-deliver the original plus one copy of each form with the fee and a self-addressed stamped envelope to the county courthouse customer counter, and keep your stamped copy as proof of filing.
For mail and in-person filing you must include two copies of each form, one for the court and one for your records, and the $250 fee covers all family members on a single application. The court returns docketed copies of the Verified Complaint, the Certification of Confidential Information, and the Order Fixing Date of Hearing with your new docket number written on them. Keep every stamped copy and mailing receipt in one folder.
What Happens After You File
Once the court receives your packet, it assigns a separate docket number to each person and writes it on the returned copies. The judge sets a hearing date on the Order Fixing Date of Hearing, which is the day you appear in court. Until then, your Form CN-12164 sits in the sealed portion of the file, away from public view.
Before the hearing you must notify the State. You mail a copy of the Order Fixing Date of Hearing to the Director of the Division of Criminal Justice in Trenton by regular and certified mail at least 20 days before the hearing. If you or your child have criminal charges pending, you also send the Verified Complaint and the Certification of Confidential Information to the County Prosecutor, and for a minor you notify the child’s other parent.
At the hearing you present proof of your current name, and if all statutory requirements are met the judge signs the Final Judgment and the sealed Final Judgment Addendum. Within 45 days you must send a certified, sealed copy of the Final Judgment with the Addendum to the Department of Treasury with a $50 fee, notify the Registrar of Vital Statistics, and present the judgment in person to the Motor Vehicle Commission if you drive. The effective date on the judgment, not the hearing date, is when you may start using your new name.
Mistakes to Avoid When Filling Out the Form
Each error below has a direct, costly consequence. Read them before you sign.
- Entering one wrong digit in the Social Security number. The identity cross-check fails and your case freezes until you correct it.
- Signing the new name instead of your current name. The certification becomes false, because you have not legally changed your name yet.
- Leaving the Social Security field blank “for privacy.” The court cannot verify you and will not process the application.
- Writing a guessed docket number in the blank. The clerk must untangle the confusion, delaying docketing.
- Using a P.O. Box as your residence in Statement 1. Venue and notice can break down, since residency must be a physical address.
- Filing in the wrong county. The court may reject venue, forcing you to refile where you actually reside.
- Mismatching the name between this form and the Verified Complaint. The inconsistency gets flagged and can stall the case.
- Printing on legal-size or colored paper. The clerk rejects the filing outright.
- Forgetting to file a separate CN-12164 for each person. Any person without their own form is left out of the order.
- Transposing a parent’s and child’s Social Security numbers on Form F1. Both identity checks fail at once.
- Skipping the date on the signature line. An undated certification is incomplete and may be returned.
- Mailing without certified mail receipts. You lose your proof of filing and proof of State notice.
Do’s and Don’ts
Do:
- Do copy your Social Security number straight from the card, because memory errors are the top cause of holds.
- Do file a separate form for each person, because each name change gets its own docket number.
- Do keep stamped copies and certified-mail green cards, because they are your proof of filing and notice.
- Do match this form to your Verified Complaint word for word, because inconsistencies invite delay.
- Do confirm the June 11, 2021 revision date, because outdated forms can be rejected.
- Do file in your county of residence, because venue follows where you actually live.
Don’t:
- Don’t sign the name you want, because you do not legally hold it until the judge signs the judgment.
- Don’t leave the Social Security field empty, because the sealed sheet is what keeps it private.
- Don’t use a P.O. Box for residence, because the form asks where you physically reside.
- Don’t guess a docket number, because the court assigns it after filing.
- Don’t put the new name in the case caption, because it confuses who is filing.
- Don’t email confidential data to the clerk, because the sealed form is the only secure channel for it.
Pros and Cons of Filing on Your Own vs. With Help
Many New Jersey name changes are filed pro se, but the choice depends on your comfort with court rules and your case’s complexity.
Pros of filing on your own:
- You save attorney fees, since the only required cost is the $250 court fee.
- The packet is designed for self-filers, with plain-language instructions from the Judiciary.
- You control the timeline, filing as soon as your documents are ready.
- Court staff can explain procedure, even though they cannot give legal advice.
- JEDS makes online filing simple, reducing trips to the courthouse.
Cons of filing on your own:
- One field error can delay you weeks, because there is no professional to catch it first.
- Notice rules are easy to miss, especially the 20-day Division of Criminal Justice mailing.
- Pending criminal charges complicate filing, requiring extra prosecutor notice you must handle alone.
- Minor cases add a parental-notice layer, which trips up many self-filers.
- You bear full responsibility for accuracy, since the court reminds you that you own the content of your papers.
FAQs
Is Form CN-12164 the same as the Certification of Confidential Information for Name Change?
Yes. It is the New Jersey form numbered CN-12164, appearing as Form A1 for adults and Form F1 for minors inside the official name change packets.
Do I write my current name or my new name in the signature line?
No, you do not sign the new name. You sign your current legal name, because the court has not yet granted the change you are requesting.
Do I put my Social Security number on the public Verified Complaint too?
No. The complaint only states that your number is in the attached confidential certification, which keeps it sealed and out of the public file.
Is the $250 fee charged for Form CN-12164 by itself?
No. The $250 fee covers the entire name change application, and one fee covers all family members filed together; the form itself has no separate charge.
Do I need a separate CN-12164 for each family member?
Yes. Each person changing their name files their own certification and receives a separate docket number.
Do I write the docket number on the form before filing?
No. Leave the Docket No. line blank, because the court assigns the number and writes it on the copies it returns to you.
Is a P.O. Box acceptable in the residence statement?
No. Statement 1 asks for your physical residence, so list a street address even if you receive mail at a box.
Do I list the child’s Social Security number or my own on Form F1?
Yes, list the child’s number in Statement 2, because the minor’s identity is what the court verifies on the child’s form.
Is Form CN-12164 ever made public?
No. It is kept in the sealed portion of the file, and the related Final Judgment Addendum states it shall not be made public in any form.
Do I file this form online?
Yes. You can submit it through the JEDS portal, by mail, or in person at your county courthouse.
Is filing without a lawyer allowed for this form?
Yes. The Judiciary publishes the packet for self-represented filers, though it recommends getting a lawyer for complex cases.
Do I need to notify anyone after filing this confidential form?
Yes. You must mail the Order Fixing Date of Hearing to the Division of Criminal Justice at least 20 days before the hearing, plus extra notice if charges are pending or a minor is involved.
Is the revision date important on this form?
Yes. Confirm the footer reads June 11, 2021, because the court can reject an outdated version.
Do I use any paper size for the form?
No. It must be on 8½” x 11” white paper, because other sizes or colors are rejected by the clerk.
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