For Clerk’s Use Only Person Filing Document: ______________________________________ Mailing Address: ______________________________________ City, State, Zip Code: ______________________________________ Daytime/Evening Phone Number: ______________________________________ ATLAS Number (if applicable) ______________________________________ Attorney Bar Number (if applicable) ______________________________________ Represented by Self (No Attorney) OR by Attorney SUPERIOR COURT OF ARIZONA IN MOHAVE COUNTY In the Matter of Case Number: _____________________________ CONSENT OF MINOR TO NAME CHANGE A Minor (if minor is 14 or older) REQUIRED INFORMATION FROM MINOR, UNDER OATH OR AFFIRMATION 1. INFORMATION ABOUT ME: Name on Birth Certificate: First: ______________________ Middle: ____________________ Last: _____________________ Address:___________________________________________________________________________ Telephone: _________________________________________________________________________ Date of Birth: ________________________ Month Place of Birth: _______________________ City ______________________ Date ______________________ State _________________ Year _________________ Nation I am the minor who is the subject of this name change request. I am at least 14 years of age. 2. I have read the Application for Name Change and consent to changing my legal name to: First: ______________________ Middle: ____________________ 3. Last: _____________________ I waive notice of all further proceedings in this matter. OATH OR AFFIRMATION STATE OF ARIZONA ) COUNTY OF MOHAVE ) ss. The contents of this document are true and correct to the best of my knowledge and belief. Signature: _____________________________________ Date: _________________________ Sworn to or affirmed before me on this ___________________ day of __________________, 20____________ By: ___________________________________ My Commission Expires:_________________________ _____________________________________ Notary Public or Deputy Clerk 10/27/2006 American LegalNet, Inc. www.FormsWorkflow.com