(1) Person Filing: Street Address: City, State, Zip: Phone Number: Representing Self SUPERIOR COURT OF ARIZONA, COUNTY OF COCONINO In the Matter of the Application of Case Number: ORDER CHANGING NAME OF: (2) THE COURT FINDS: Each person whose name change is requested is a resident of Coconino County. If a name change is requested for a minor, the minor's natural or adopted parents agree to the name change. Good cause exists to grant the request. THE COURT ORDERS: (4) The Current Name Is Changed to the New Name Birthdate (3) [ ] AN ADULT AND/OR [ ] A MINOR This order does not end any rights or obligations under the original name. (5) [ ] Date: The Department of Vital Records shall issue a new birth certificate reflecting the new name for each name change ordered. Judicial Officer: Revised April 2007 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkflow.com