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YAKIMA COUNTY DISTRICT COURT In the Matter of the Change of Name of: NO.:_________________________________ _____________________________________, [Legibly print or type the minor's name here] Petitioner By: _________________________________, Parent/Legal Guardian ORDER CHANGING NAME [MINOR] I. BASIS 1.1 A verified Petition was filed with the Court by a parent or guardian of the above named minor child requesting that the name of: First: be changed to First: Middle: Last: Middle: Last: 1.2 A hearing was held on the date written below at which the Court took testimony under oath. 1.3 The minor is is not subject to the jurisdiction of the Washington Sate Department of Corrections. 1.4 The minor is is not subject to the sex offender registration laws of the State of Washington. II. FINDINGS Based on the case record to date and the testimony at the hearing, the Court finds: 2.1 The statements in the Petition are true. ORDER NAME CHANGE MINOR 5/2004 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 2.2 The minor is subject to the sex offender registration laws of the State of Washington. The Court finds the name change would not interfere with legitimate law enforcement interests, or that the Petition was made for religious or legitimate cultural reasons or in recognition of marriage or dissolution of marriage. The minor is subject to the jurisdiction of the Washington State Department of Corrections. The Court finds the name change would not interfere with legitimate penological interest, or that the Petition was made for religious or legitimate cultural reasons or in recognition of marriage or dissolution of marriage. 2.3 The Petition for Change of Name is not made for any illegal or fraudulent purpose. 2.4 The Petition for Change of Name will not be detrimental to the interest of any other person. 2.5 Parental notice: Both parent or legal guardians of the minor child consented to the name change in open court or by verified written statement made under penalty of perjury. The parent or legal guardian who has not consented to the change of minor's name was notified of this hearing as provided in L-CRLJ 65(b). The non-consenting parent Did Did not appear at the hearing. The non-consenting parent's legal rights were previously terminated by court order and no notification is required. The Court finds that notification to the non-consenting parent would not be in the best interest of the child. III. ORDER It is ORDERED: The name of First: is changed to First: for all purposes. 3.1 Petitioner shall provide a copy of this Order within five days to the Washington State Department of Corrections if (s) he is subject to the jurisdiction of that Department. Petitioner shall provide a copy of this order within five days to the Yakima County Sheriff's Office and the Washington State Patrol if (s) he is subject to the sex offender registration laws of this state. FAILURE TO ABIDE BY THIS SECTION IS A CRIME PUNISHABLE BY JAIL AND FINES. Date JUDGE/COURT COMMISSIONER I do hereby certify that the foregoing instrument is a true and correct copy of the original now on file in Yakima District Court, in Witness Whereof, I hereby set my hand this _______ day of __________________, 20_______ By: _____________________________________________, Deputy Clerk Middle: Last: Middle: Last: ORDER NAME CHANGE MINOR 5/2004 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com