Nevada > County > Washoe > District Court > Family
Petition For Legal Change Of Name 3490 - Nevada
| Petition For Legal Change Of Name 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 Petition 11 Of 12 ________________________________, Case No. __________________ (Your present name) 13 Dept. No.__________________ For a change of name. 14 ________________________________/ 15 16 PETITION FOR LEGAL CHANGE OF NAME 17 ____________________________________________________, acting in proper person, 18 (Your present name) 19 petitions this Court as follows: 20 I. 21 Petitioner,___________________________________, was born in _____________________, (Your present name) (City)22 _______________________, on _________________________to ____________________________ 23 (State) (Date of birth) (Fathers name)24 ___________________ and ______________________________________, who __________________ (Mothers name) (Were or were not)25 husband and wife. 26 My Social Security Number is:____________________________________. 27 28 Ct. App. 7/99 1 <<<<<<<<<********>>>>>>>>>>>>> 2 1 II. 2 I wish to change my name from _______________________________________________ to 3 ____________________________________________________ because: 4 ________________________________________________________________________________ 5 (State reason for wanting name change) ________________________________________________________________________________ 6 ________________________________________________________________________________ 7 ________________________________________________________________________________ 8 ________________________________________________________________________________ 9 ________________________________________________________________________________10 ________________________________________________________________________________11 ________________________________________________________________________________12 ________________________________________________________________________________13 ________________________________________________________________________________14 ________________________________________________________________________________15 ________________________________________________________________________________16 ________________________________________________________________________________17 III.18 I ____________________ been convicted of a felony. 19 (Have or have not) 20 If I have been convicted of a felony, each offense, the date of conviction, the County and21 State of conviction, and the final result are as follows: 22 ________________________________________________________________________________23 ________________________________________________________________________________24 ________________________________________________________________________________25 ________________________________________________________________________________26 _______________________________________________________________________________.27 I am not seeking a name change for any illegal purpose.28 Ct. App. 7/99 2<<<<<<<<<********>>>>>>>>>>>>> 3 1 IV. 2 I currently reside at: 3 ___________________________ (Address) 4 ____________________________ 5 ____________________________ 6 ____________________________ 7 (Telephone number) 8 and I have lived there since __________________________ and have been a resident of Nevada for (When you moved to present address) 9 ______________________________________. My previous address was:____________________ 10 (Length of time you have lived in Nevada) (Your previous address)11 _____________________________________________, and I resided there for ________________ (How long you lived there)12 V. 13 I am requesting that my name be legally changed 14 to__________________________________ 15 _______________________________________________. 16 DATE:______________________________ 17 ________________________________18 (Print name) 19 ________________________________ (Signature) 20 ________________________________21 (Address) 22 ________________________________23 ________________________________ (Telephone number)24 25 26 27 28 Ct. App. 7/99 3 <<<<<<<<<********>>>>>>>>>>>>> 4 1 VERIFICATION 2 STATE OF NEVADA ) ) ss: 3 County of ________________) 4 _______________________________________, being first duly sworn under penalties of (Your name) 5 perjury, deposes and says: 6 I am the Petitioner in the above-entitled action; that all the claims and allegations in the 7 Petition are true of my own knowledge, except for those matters therein contained stated upon 8 information and belief, and as to those matters I believe them to be true. 9 10 _____________________________________11 (Signature) 12 SUBSCRIBED and SWORN to before me 13 this _______ day of __________________,__________ 14 ________________________________________ 15 NOTARY PUBLIC 16 ACKNOWLEDGMENT 17 STATE OF NEVADA ) 18 )ss: County of Washoe ) 19 On this _____day of __________________,__________, personally appeared before me, the20 undersigned, a Notary Public in and for the County of Washoe, State of 21 Nevada,_________________ _________________________________, personally known to me or22 proved to me, to be the person whose name is subscribed to the attached instrument who23 acknowledged that (she/he) ____________ executed the attached instrument. 24 ______________________________25 NOTARY PUBLIC26 27 28 Ct. App. 7/99 4
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