SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY In the Matter of: For Clerk's Use Only Name of Applicant Case Number: ORDER CHANGING NAME OF AN ADULT THE COURT FINDS: 1. This case has come before this Court to change the current legal name of the Applicant. to change the birth record of the Applicant This Court has jurisdiction to change the legal name and/or the Birth Record of the Applicant. Good cause exists to grant the application for change of name. 2. 3. THE COURT ORDERS: 1. The current legal name of the Applicant: First Date of Birth: Month Place of Birth: City IS CHANGED TO: First Middle Last State Nation Day Year Middle Last The Birth record name of the Applicant: First Middle Last Date of Birth: ___________________________________________________________________ Month Day Year Place of Birth: City IS CHANGED TO: First © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED State Nation Middle Page 1 of 2 Last CVNC81f-053012 American LegalNet, Inc. www.FormsWorkFlow.com ORD Case No. ________________________ 2. 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 as above ordered. For a person born in any other state,, to the extent that the agency that maintains birth records in that state is authorized to honor an order of this Court, that agency is requested or ordered to amend its birth records to reflect the new name as above ordered. 3. 4. This Order does not release the Applicant from any obligations incurred or harm any rights of property or action in any original name. Other orders: DONE IN OPEN COURT: Date . Judicial Officer Page 2 of 2 © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED CVNC81f-053012 American LegalNet, Inc. www.FormsWorkFlow.com ORD