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Petition for Name Change 226 Individual KCDC 2018 KING COUNTY DISTRICT COURT STATE OF WASHINGTON In re the Petition of: Current First Middle Last No. PETITION FOR NAME CHANGE (Individual) (CLERK222S ACTION REQUIRED) [legibly print name]. Middle My current full legal name is: LastFirst I request a court order changing my current name to: [legibly print full new name]. 1.I reside in King County, Washington.Yes No 2.I am required to register as a sex offender.Yes No [Petitioner222s failure to provide required notice to the King County Sheriff and Washington State Patrol is a crime. RCW 9A.44.130; RCW 4.23.130] 3.I am under the jurisdiction of the Department of Corrections. Yes No [Petitioner222s failure to provide required notice to DOC is a crime, RCW 4.24.130.] 4.I have had a name change prior to this petition. Please explain. (Date, place, reason.) 5.I request a name change for the following reason(s). Please explain: 6.My name change petition is not made for any illegal or fraudulent purposes.7.My name change will not be detrimental to the interests of anyone else. I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING STATEMENTS ARE TRUE AND CORRECT. Signed at , Washington, on . City Date Petitioner222s Signature Petitioner222s Street Address/PO Box City, State, Zip First Middle Last American LegalNet, Inc. www.FormsWorkFlow.com