Nevada > County > Washoe > District Court > Family
Petition For Change Of Minors Name (One Parent Petitioning) 3490 - Nevada
| Petition For Change Of Minors Name (One Parent Petitioning) Form. This is a Nevada form and can be used in Family District Court Washoe County . |
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1 Code: $3490 Name 2 Address 3 Telephone Number Acting In Proper Person 4 5 6 IN THE FAMILY DIVISION 7 OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA 8 IN AND FOR THE COUNTY OF WASHOE 9 10 In The Matter of the Application Of 11 (Parents name making application) 12 Case No. natural of the minor 13 (Mother or Father) Dept. No.14 child (Childs name) 15 for the change of name of 16 (Her or His) minor child. 17 ______________________________________/ 18 PETITION FOR CHANGE OF MINORS NAME 19 The Petition of respectfully shows as follows: (Your name) 20 1. Petitioner, , is a resident of the21 (Your name) 22 County of Washoe, State of Nevada, and resides at: (Street address)23 and has resided at that address since24 (City) (Zip Code) 25 and the child has resided with the Petitioner (State how long you have lived at that address) 26 at that address since 27 (State how long child has resided with you at that address) 28 Ct. App. 7/99 1 <<<<<<<<<********>>>>>>>>>>>>> 2 1 2. Petitioner, , is the natural 2 (Your name) (Mother or Father) 3 of the minor child, , and the m borninor child was (Childs name) 4 in on 5 (City and State of childs birth) (Date of birth) 6 3. Petitioner, wishes to have the minor 7 (Your name) 8 childs name changed from: (Childs present name) 9 to because:10 (Childs new name) 11 (State in detail the reasons you want to change the childs name) 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 4. Petitioner ever been convicted of a felony. (Has or has not) 27 28 Ct. App. 7/99 2 <<<<<<<<<********>>>>>>>>>>>>> 3 1 5. If Petitioner has ever been convicted of a felony state the date, location, and offenses: 2 3 4 5 6 6. This change of name is requested for no unlawful purpose. 7 7. , the other natural parent of the child (Other parents name) 8 been notified of this Petition to change the name of the minor child. 9 (Has or has not) 10 (If other parent has not been notified of this Petition, explain in detail why no notice has been given to the other parent) 11 12 13 14 15 16 17 18 19 DATE:_________________________________________ 20 21 (Print name)22 _________________________________ (Signature)23 (Address)24 SUBSCRIBED and SWORN to before me 25 this _________day of ______________, __________. (Telephone number)26 ___________________________________ 27 NOTARY PUBLIC 28 Ct. App. 7/99 3 <<<<<<<<<********>>>>>>>>>>>>> 4 1 VERIFICATION 2 STATE OF NEVADA ) )ss: 3 County of Washoe ) 4 , being first duly sworn, under penalties of perjury, deposes and says: 5 I am the in the above-entitled action; that I have read the foregoing 6 document and am competent to testify of its contents of my own knowledge and the contents are true 7 of my own knowledge except for those matters stated therein on information and belief, and, as to those 8 matters, I believe them to be true. 9 ____________________________________10 ACKNOWLEDGMENT 11 STATE OF NEVADA ) 12 )ss: County of Washoe ) 13 On this _____day of __________________, _________, personally appeared before me, the14 undersigned, a Notary Public in and for the County of Washoe, State of Nevada, 15 _________________________________, personally known to me or proved to me, to be the person16 whose name is subscribed to the attached instrument who acknowledged that (she/he) ________17 executed the attached instrument. 18 ______________________________19 NOTARY PUBLIC20 21 22 23 24 25 26 27 28 Ct. App. 7/99 4
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