Person Filing Petition: Name: Address: Telephone No. IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of a Change of Name for: A Minor Child (current legal name) Date of Birth By: Petitioner (parent or legal guardian) , , , ) ) ) ) ) ) ) ) ) CASE NO. PETITION TO CHANGE CHILD'S NAME CI Petitioner requests that the Court change the name of the minor child as follows: 1. 2. The minor child's current legal name is First Name Middle Name Last Name I wish the child to take and be legally known by a new name, which is: First Name Middle Name Last Name 3. 4. I am the minor child's legal mother father guardian. Consent to this name change by the minor child's: mother father Name of Non-Petitioning Parent is attached. is not attached. is not necessary because: this parent is deceased. A certified copy of the child's birth certificate and the parent's death certificate are attached. parental rights were terminated on in a court in the state of other: The reasons for this request are: 5. Page 1 of 2 CIV-694 (6/15)(cs) PETITION TO CHANGE CHILD'S NAME Civil Rule 84(e) AS 09.55.010 6. This name change is sought 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 have read this document and believe all statements made in it are true. Date Petitioner's Signature Printed Name Subscribed and sworn to or affirmed before me at on . (Date) , Alaska (SEAL) Clerk of Court, Notary Public or other person authorized to administer oaths. My commission expires: Page 2 of 2 CIV-694 (6/15)(cs) PETITION TO CHANGE CHILD'S NAME American LegalNet, Inc. www.FormsWorkFlow.com Civil Rule 84(e) AS 09.55.010