Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: Lawyer222s Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Case Number: CV In the Matter of : CONSENT OF (OTHER) PARENT* TO AMENDMENT OF BIRTH CERTIFICATE OF A MINOR and WAIVER OF NOTICE Minor whose birth certifica te needs correction *or LEGAL GUARDIAN UNDER OATH OR BY AFFIRMATION 1. REQUIRED INFORMATION ABOUT THE PARENT* or LEGAL GUARDIAN other than the one filing the 223Petition to Amend Birth Certificate224 of the minor. My Full Name is: Address: Telephone: Email : I am the Minor222s MOTHER FATHER Legal Guardian. (Information below for parent only. Not required for legal guardian.) Date of Birth: Place of Birth : Mon th / Date / Year City or County, State, Nation FOR CLERK USE ONLY 251 Superior Court of Arizona in Maricopa County CVABM17f 226 092917 ALL RIGHTS RESERVED Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 2. I have read the Petition to Amend a Birth Certificate for a Minor and consent to the corrections specified in the Petition concerning the minor child named above. 3. I waive notice of all further proceedings in this matter. UNDER PENALTY OF PERJURY I swear or affirm under penalty of perjury that the contents of this document are true and correct to the best of my knowledge and belief. Date Signature of Non - Petitioner Parent or Guardian Printed Name STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: by (date) . (notary seal) Deputy Clerk or Notary Public 251 Superior Court of Arizona in Maricopa County CVABM17f 226 092917 ALL RIGHTS RESERVED Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com