IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Change of Name for: , ) ) ) ) ) ) ) Petitioner (current legal name) Date of Birth CASE NO. PETITION FOR CHANGE OF NAME CI I, the petitioner, request that the Court enter a judgment changing my name as follows: 1. 2. My current legal name is First Name Middle Name Last Name I want to take and be legally known by a new name, which is: First Name Middle Name Last Name 3. The reasons for this request for a change of name are: 4. I ask for this name change for personal reasons and not to avoid judgments, debts, obligations, or to defraud any person. The reasons stated are consistent with the public interest. VERIFICATION I state on oath or affirm that I read this document and believe all statements in it are true. Date Mailing Address Daytime Phone Subscribed and sworn to or affirmed before me at on . (Date) (SEAL) Petitioner's Signature City State Email Address , Alaska ZIP Clerk of Court, Notary Public or other person authorized to administer oaths. My commission expires Civil Rule 84 AS 09.55.010 American LegalNet, Inc. www.FormsWorkFlow.com CIV-700 (2/13)(cs) PETITION FOR CHANGE OF NAME