For Clerk's Use Only SUPERIOR COURT OF ARIZONA IN MOHAVE COUNTY In the Matter of: Applicant (Name of Person Filing Request) Case Number: ORDER CHANGING NAME FOR A FAMILY THE COURT FINDS: 1. 2. 3. 4. This case has come before this Court to change the legal names of the persons listed below. This Court has jurisdiction to change the legal names of the persons as listed below. Good cause exists to grant this application. It is in the best interest of any minor child(ren) listed below. THE COURT ORDERS: 1. The name on the birth Certificate or Current Legal Name: First: ______________________ Middle: ___________________ Last: __________________________ Date of Birth: ________________________ ________________________ _______________________ (Month) (Day) (Year) Place of Birth: _______________________ ________________________ _______________________ (City) (State) (Nation) IS CHANGED TO: First: ______________________ Middle: ___________________ Last: __________________________ The name on the birth Certificate or Current Legal Name: First: ______________________ Middle: ___________________ Last: __________________________ Date of Birth: ________________________ ________________________ _______________________ (Month) (Day) (Year) Place of Birth: _______________________ ________________________ _______________________ (City) (State) (Nation) IS CHANGED TO: First: ______________________ Middle: ___________________ Last: __________________________ 11/2/2006 Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com Case No.________________ The name on the birth Certificate or Current Legal Name: First: ______________________ Middle: ___________________ Last: __________________________ Date of Birth: ________________________ ________________________ _______________________ (Month) (Day) (Year) Place of Birth: _______________________ ________________________ _______________________ (City) (State) (Nation) IS CHANGED TO: First: ______________________ Middle: ___________________ Last: __________________________ The name on the birth Certificate or Current Legal Name: First: ______________________ Middle: ___________________ Last: __________________________ Date of Birth: ________________________ ________________________ _______________________ (Month) (Day) (Year) Place of Birth: _______________________ ________________________ _______________________ (City) (State) (Nation) IS CHANGED TO: First: ______________________ Middle: ___________________ Last: __________________________ The name on the birth Certificate or Current Legal Name: First: ______________________ Middle: ___________________ Last: __________________________ Date of Birth: ________________________ ________________________ _______________________ (Month) (Day) (Year) Place of Birth: _______________________ ________________________ _______________________ (City) (State) (Nation) IS CHANGED TO: First: ______________________ Middle: ___________________ Last: __________________________ 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 ordered above. Note that except for correction of error, a woman's maiden name as recorded on the birth record, is unaffected by an Order for Change of Name (or by marriage). For a person born in a state other than Arizona, 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 it's birth records to reflect the new name(s) as ordered above. 11/2/2006 Page 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com Case No.__________________ 3. 4. This Order does not release the persons named above 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 11/2/2006 Page 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com