Preview
FILED: ERIE COUNTY CLERK 04/10/2024 09:43 AM INDEX NO. 805109/2024
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 04/10/2024
New York State Unified Court System
UCS-NC1
Name Change and/or Sex (07/2023)
Page 1 of 4
Designation Change Petition
for Individual Adult (perSon 18 or over)
Supreme B Court
County of Erie 8
Petitioner (Your Present Name): Index Number:
ANTHONY JAMES FRAZIER
I am requesting a Court Order for the following (check all that apply):
B Name Change (complete Section A below)
8 Sex Designation Change (complete Section B below)
Please note:
" A court order is not required under New York law to change your sex designation on an identity
document (birth certificate, driver's license, photo ID, etc.) issued in New York.
" state has its own requirements for a sex designation change. Some states not honor sex
Every may
designation change orders from New York courts. If you want to change an identity document
issued in another state, you should check that state's requirements before you file an application.
" This application is for a declaratory judgment. A declaratory judgment states a fact under the law. If
granted, the sex designation change order legally recognizes your gender identity.
Are you asking the judge to seal the record for your personal safety? O Yes O No
"Restricted"
NOTE: If yes, the clerk will temporarily enter your case as (your name and case
information will be private) until the judge makes a final decision about sealing your case.
SECTION A: NAME CHANGE (complete this section for a name change)
1. Your Requested New Name: TREASURE MO-NIQUE FRAZIER
2. Your Place of Birth (Street Address, City/Town/Village, State, Zip, Country):
BUFFALO, NEW YORK
Note: You must attach Proof of birth to this petition.
" If you were bom outside of the State of New York, proof of birth can include a birth certificate, passport,
or any other legal document which shows the date and place of your birth.
" If you were born in the State of New York, you must attach one of the following:
o Certified Copy of your government-issued birth document (i.e., Birth Certificate/Certification of Birth):
" If you were born in New York you can get a certified of your birth document from the
City, copy
" If you were born outside New York you can get a certified of your birth document from
City, copy
the
o Certified Transcript of your Birth Certificate
o Certificate from Commissioner or local Board of Health stating no such Certificate is available
ADA Accommodations Spoken or Sign Language Interpreters 1-800-C URT N
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FILED: ERIE COUNTY CLERK 04/10/2024 09:43 AM INDEX NO. 805109/2024
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 04/10/2024
UCS-NC1 Page 2 of 4 Index Number:
(07/2023)
3. Have you ever been convicted of a crime? O Yes ® No
'Yes'
If you answered to question 3, you must answer questions 4 and 5.
4. Court where you were convicted:
5. Crime for which you were convicted:
6. Have you ever filed for bankruptcy? O Yes ® No
7. Are there any judgments or liens against you? O Yes ® No
8. Are you a party in a lawsuit or other court case? O Yes ® No
Žes'
If you answered to question 6, 7 or 8, provide details below, including the court where it was
filed, the date it was filed, and the case number (if known).
9. Are you currently married? O Yes @ No
10.Were you previously married? O Yes @ No
11.Do you have any children under 21? O Yes ® No
12.Do you have to pay child support? O Yes ® No
Žes'
If you answered to question 12, you must answer questions 13, 14 and 15.
13.Are your child support payments up to date? O Yes O No
'No,'
If how much do you owe? $
14.Court that issued the child support order:
15.Child Support Collections Unit:
16.Do you have to pay spousal support? O Yes ® No
Žes'
If you answered to question 16, you must answer questions 17 and 18.
17.Are your spousal support payments up to date? O Yes O No
'No,'
If how much do you owe? $
18.Court that issued the spousal support order:
19.Have you ever filed a name change petition before? O Yes @ No
Žes,'
If provide details below, including the court where you filed the petition, the date that you
filed it, the case number (if known), and the result.
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FILED: ERIE COUNTY CLERK 04/10/2024 09:43 AM INDEX NO. 805109/2024
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 04/10/2024
UCS-NC1 (07/2023) Page 3 of 4 Index Number:
20.What are your reasons for changing your name?
Provide details below.
The Petitioner requests a name that aligns with her gender identity.
SECTION B: SEX DESIGNATION CHANGE (complete this section for a sex designation change)
21.Your new sex designation: Female8
22.Have you ever filed a sex designation change petition before? O Yes ® No
Yes,'
If provide details below, including the court where you filed the petition, the date that you
filed it, the case number (if known), and the result.
23.Do you want to provide your reasons for changing your sex designation? O Yes O No
Žes,' 'No,'
If you may provide details below. If leave this question blank. Please note, this
information is optional and is not required for a court order to change your sex designation.
SECTION C: PERSONAL INFORMATION (all applicants must complete this section)
24.Your Present Name: ANTHONY JAMES FRAZIER
25.Your Age: 28
26.Your Date of Birth (Month/Day/Year): 02/27/1995
27.Your Current Address (Street Address, City/Town/Village, State, Zip, Country):
NOTE: The court may require you to show proof of address when you file your petition.
66 CUSTER STREET, BUFFALO, NEW YORK, 14214
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FILED: ERIE COUNTY CLERK 04/10/2024 09:43 AM INDEX NO. 805109/2024
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 04/10/2024
UCS-NC1 Page 4 of 4 Index Number:
(07/2023)
28.Should this court record be sealed for your personal safety? ® Yes O No
'Yes,'
If provide details below.
Based on fear of violence, discrimination, and hate crimes against the transgender community,
the Petitioner respectfully requests this Court to seal all court records, in the matter during the
pendency of this proceeding and permanently thereafter.
29.Have you attached any supporting documents or additional pages? O Yes ® No
Žes,'
If list the name or a description of the document(s) below.
30.I respectfully request a Court Order permitting my Bname change and/or Esex
designation change.
Petitioner ignature Date
VERIFICATION
State of New York, County of Erie B ss.:
, ANTHONY JAMES FRAZIER , the petitioner, being duly sworn,
have read the above petition and say that the information in the petition is true and accurate to the
best of my knowledge and belief. .
Petitioner nature in Pre nce of Notary
Sw in to before me this 6th
d of F bruary , , 2026
PEARUNE MA
Notary Public, State of
New
Note: You can complete and submit a Fee Waiver Application form the court to waive the
asking filing
fees for your application if you qualify. A fillable Fee Waiver Application form is available at:
4 of 4
Preview
FILED: ERIE COUNTY CLERK 04/10/2024 09:43 AM INDEX NO. 805109/2024 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 04/10/2024 New York State Unified Court System UCS-NC1 Name Change and/or Sex (07/2023) Page 1 of 4 Designation Change Petition for Individual Adult (perSon 18 or over) Supreme B Court County of Erie 8 Petitioner (Your Present Name): Index Number: ANTHONY JAMES FRAZIER I am requesting a Court Order for the following (check all that apply): B Name Change (complete Section A below) 8 Sex Designation Change (complete Section B below) Please note: " A court order is not required under New York law to change your sex designation on an identity document (birth certificate, driver's license, photo ID, etc.) issued in New York. " state has its own requirements for a sex designation change. Some states not honor sex Every may designation change orders from New York courts. If you want to change an identity document issued in another state, you should check that state's requirements before you file an application. " This application is for a declaratory judgment. A declaratory judgment states a fact under the law. If granted, the sex designation change order legally recognizes your gender identity. Are you asking the judge to seal the record for your personal safety? O Yes O No "Restricted" NOTE: If yes, the clerk will temporarily enter your case as (your name and case information will be private) until the judge makes a final decision about sealing your case. SECTION A: NAME CHANGE (complete this section for a name change) 1. Your Requested New Name: TREASURE MO-NIQUE FRAZIER 2. Your Place of Birth (Street Address, City/Town/Village, State, Zip, Country): BUFFALO, NEW YORK Note: You must attach Proof of birth to this petition. " If you were bom outside of the State of New York, proof of birth can include a birth certificate, passport, or any other legal document which shows the date and place of your birth. " If you were born in the State of New York, you must attach one of the following: o Certified Copy of your government-issued birth document (i.e., Birth Certificate/Certification of Birth): " If you were born in New York you can get a certified of your birth document from the City, copy " If you were born outside New York you can get a certified of your birth document from City, copy the o Certified Transcript of your Birth Certificate o Certificate from Commissioner or local Board of Health stating no such Certificate is available ADA Accommodations Spoken or Sign Language Interpreters 1-800-C URT N 1 of 4 FILED: ERIE COUNTY CLERK 04/10/2024 09:43 AM INDEX NO. 805109/2024 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 04/10/2024 UCS-NC1 Page 2 of 4 Index Number: (07/2023) 3. Have you ever been convicted of a crime? O Yes ® No 'Yes' If you answered to question 3, you must answer questions 4 and 5. 4. Court where you were convicted: 5. Crime for which you were convicted: 6. Have you ever filed for bankruptcy? O Yes ® No 7. Are there any judgments or liens against you? O Yes ® No 8. Are you a party in a lawsuit or other court case? O Yes ® No Žes' If you answered to question 6, 7 or 8, provide details below, including the court where it was filed, the date it was filed, and the case number (if known). 9. Are you currently married? O Yes @ No 10.Were you previously married? O Yes @ No 11.Do you have any children under 21? O Yes ® No 12.Do you have to pay child support? O Yes ® No Žes' If you answered to question 12, you must answer questions 13, 14 and 15. 13.Are your child support payments up to date? O Yes O No 'No,' If how much do you owe? $ 14.Court that issued the child support order: 15.Child Support Collections Unit: 16.Do you have to pay spousal support? O Yes ® No Žes' If you answered to question 16, you must answer questions 17 and 18. 17.Are your spousal support payments up to date? O Yes O No 'No,' If how much do you owe? $ 18.Court that issued the spousal support order: 19.Have you ever filed a name change petition before? O Yes @ No Žes,' If provide details below, including the court where you filed the petition, the date that you filed it, the case number (if known), and the result. 2 of 4 FILED: ERIE COUNTY CLERK 04/10/2024 09:43 AM INDEX NO. 805109/2024 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 04/10/2024 UCS-NC1 (07/2023) Page 3 of 4 Index Number: 20.What are your reasons for changing your name? Provide details below. The Petitioner requests a name that aligns with her gender identity. SECTION B: SEX DESIGNATION CHANGE (complete this section for a sex designation change) 21.Your new sex designation: Female8 22.Have you ever filed a sex designation change petition before? O Yes ® No Yes,' If provide details below, including the court where you filed the petition, the date that you filed it, the case number (if known), and the result. 23.Do you want to provide your reasons for changing your sex designation? O Yes O No Žes,' 'No,' If you may provide details below. If leave this question blank. Please note, this information is optional and is not required for a court order to change your sex designation. SECTION C: PERSONAL INFORMATION (all applicants must complete this section) 24.Your Present Name: ANTHONY JAMES FRAZIER 25.Your Age: 28 26.Your Date of Birth (Month/Day/Year): 02/27/1995 27.Your Current Address (Street Address, City/Town/Village, State, Zip, Country): NOTE: The court may require you to show proof of address when you file your petition. 66 CUSTER STREET, BUFFALO, NEW YORK, 14214 3 of 4 FILED: ERIE COUNTY CLERK 04/10/2024 09:43 AM INDEX NO. 805109/2024 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 04/10/2024 UCS-NC1 Page 4 of 4 Index Number: (07/2023) 28.Should this court record be sealed for your personal safety? ® Yes O No 'Yes,' If provide details below. Based on fear of violence, discrimination, and hate crimes against the transgender community, the Petitioner respectfully requests this Court to seal all court records, in the matter during the pendency of this proceeding and permanently thereafter. 29.Have you attached any supporting documents or additional pages? O Yes ® No Žes,' If list the name or a description of the document(s) below. 30.I respectfully request a Court Order permitting my Bname change and/or Esex designation change. Petitioner ignature Date VERIFICATION State of New York, County of Erie B ss.: , ANTHONY JAMES FRAZIER , the petitioner, being duly sworn, have read the above petition and say that the information in the petition is true and accurate to the best of my knowledge and belief. . Petitioner nature in Pre nce of Notary Sw in to before me this 6th d of F bruary , , 2026 PEARUNE MA Notary Public, State of New Note: You can complete and submit a Fee Waiver Application form the court to waive the asking filing fees for your application if you qualify. A fillable Fee Waiver Application form is available at: 4 of 4