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Name Change Criminal History Assessment LACIV 226 - California
| Name Change Criminal History Assessment Form. This is a California form and can be used in Civil Los Angeles Local County . |
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CONFIDENTIAL NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: (Person submitting the application) STATE BAR NUMBER Reserved for Clerk's File Stamp ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURTHOUSE ADDRESS: NAME OF PETITIONER (Person having the name change): CASE NUMBER: NAME CHANGE CRIMINAL HISTORY ASSESSMENT COURT DATE: Top portion of the form above and number one (1) below to be completed by Petitioner. 1. Sex Race/Ethnicity Date of Birth Age Social Security Driver's License or ID Place of Birth Current Address Other name(s) used Number (2) below to be completed by County Probation Department (Code Civ. Proc., § 1279.5): 2. PTD Application No.___________________________ An automated search of the criminal history information data systems reveals the following: Petitioner is a registered sex offender. and/or Petitioner is not a registered sex offender. Petitioner is not under the Jurisdiction of the Department of Corrections. Petitioner is under the Jurisdiction of the Department of Corrections. Petitioner unable to be identified. Comments:________________________________________________________________________ _______________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Date:__________________________ By: ________________________________________ INVESTIGATOR / AIDE PROBATION DEPARTMENT PRETRIAL SERVICES DIVISION (213) 974-5821 LACIV 226 (NEW) LASC Approved 10-09 NAME CHANGE CRIMINAL HISTORY ASSESSMENT Code Civ. Proc., § 1279.5 American LegalNet, Inc. www.FormsWorkFlow.com
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