SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY For Clerk's Use Only In the Matter of: Case Number CV Petitioner (Legal Name Currently Used) ORDER AMENDING BIRTH CERTIFICATE OF AN ADULT A.R.S. § 36-337 THE COURT FINDS: 1. This case has come before this Court to amend the birth certificate of the Petitioner. 2. Pursuant to A.R.S. §36-337, this Court has jurisdiction to order that the Petitioner's birth certificate be amended to correct errors or omissions contained in the original birth certificate. 3. Good cause exists to grant the Petition to amend the birth certificate as requested by the Petitioner. 4. The Petitioner's Name, Date and Place of Birth appears on his or her Arizona birth certificate as follows: THE PRESENT NAME APPEARING ON THE SUBJECT BIRTH CERTIFICATE: First Middle Last Date of Birth: Month Day Year Place of Birth: City State Nation © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED ORD CVAB81f- 021616 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case No._______________ THE COURT ORDERS: 1. THE NAME APPEARING ON THE BIRTH CERTIFICATE IS CHANGED TO: First Middle Last 2. THAT THE BIRTH CERTIFICATE RECORDS OF THE PETITIONER BE CHANGED TO CORRECT THE FOLLOWING ERRORS OR OMISSIONS: That the birth certificate records of the Petitioner should be changed to correct the following errors or omissions - (continued) 3. For a person born in the State of Arizona, the Office of Vital Records is ordered to amend the birth record to reflect the new name or other corrected information as ordered above. This Order does not release the Applicant from any obligations incurred or harm any rights of property or action in any previous name. Other orders: 4. 5. DONE IN OPEN COURT: ____________________ Date Judicial Officer © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED ORD CVAB81f- 021616 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com